Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | N/A | FL |
NPI | 1699868299 |
---|---|
Provider Name | Mr. Charles Lynn Dale |
First Address | Largo, FL 33778-4101 |
Second Address | Bay Pines, FL 33744-5005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |