Healthcare Provider Details

I. General information

NPI: 1497799233
Provider Name (Legal Business Name): DALE CHARLES LINOWSKI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 E BROADWAY RD STE 106
MESA AZ
85206-3506
US

IV. Provider business mailing address

2314 E BEACHCOMBER DR
GILBERT AZ
85234-2883
US

V. Phone/Fax

Practice location:
  • Phone: 480-854-9833
  • Fax: 480-854-9834
Mailing address:
  • Phone: 480-663-3982
  • Fax: 480-663-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2861
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierAZ0297870
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: