Provider Demographics
NPI:1316171499
Name:DALE, MEGAN RENEE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
Last Name:DALE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 JACKS ST
Mailing Address - Street 2:
Mailing Address - City:GAS CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46933-2149
Mailing Address - Country:US
Mailing Address - Phone:765-517-0886
Mailing Address - Fax:765-628-3639
Practice Address - Street 1:9909 E 100 S
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:IN
Practice Address - Zip Code:46936-9163
Practice Address - Country:US
Practice Address - Phone:765-628-0605
Practice Address - Fax:765-628-3639
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003545A2251P0200X
IN05012774A2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics