Provider Demographics
NPI:1013450311
Name:WASHINGTON, DALE (LMT)
Entity type:Individual
Prefix:MS
First Name:DALE
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 ALTON RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4563
Mailing Address - Country:US
Mailing Address - Phone:305-699-4675
Mailing Address - Fax:413-622-4793
Practice Address - Street 1:2044 ALTON RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4563
Practice Address - Country:US
Practice Address - Phone:305-699-4675
Practice Address - Fax:413-622-4793
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA82516225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist