Provider Demographics
NPI:1386898781
Name:DIAL, TAI (DPT)
Entity type:Individual
Prefix:
First Name:TAI
Middle Name:
Last Name:DIAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TAI
Other - Middle Name:
Other - Last Name:OGUNDIPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:10845 TOWN CENTER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-2712
Mailing Address - Country:US
Mailing Address - Phone:410-257-5263
Mailing Address - Fax:410-257-5341
Practice Address - Street 1:130 HOSPITAL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4015
Practice Address - Country:US
Practice Address - Phone:410-414-4846
Practice Address - Fax:410-414-4810
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406409701Medicaid