Healthcare Provider Details

I. General information

NPI: 1477872216
Provider Name (Legal Business Name): ROBERT BARRY DALE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MADISON AVENUE SUITE 415
MEMPHIS TN
38163-0002
US

IV. Provider business mailing address

3062 BRIDGE MOORE DR
NESBIT MS
38651-8387
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-3356
  • Fax:
Mailing address:
  • Phone: 901-448-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3656
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTH7317
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number3656
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: