Active NPI
Leland E Dibble, P.T.
- Physical Therapist
- Salt Lake City, UT
National Provider Identifier
1114036985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 93-264888-2401
- Practice address
- 50 N Medical Dr
Salt Lake City, UT 84132-0001 - Phone
- (801) 581-2121
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 93-264888-2401 | UT | Primary |
Addresses
Primary practice location
50 N Medical Dr
Salt Lake City, UT 84132-0001
Mailing address
127 S 500 E
Suite 660
Salt Lake City, UT 84102-1959
Phone (801) 587-6470
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 26488824000001 | Other | UT | BLUE CROSS BLUE SHIELD ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 93-264888-2401 | UT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187568000000",
"number": "1114036985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "127 S 500 E",
"address_2": "SUITE 660",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841021959",
"telephone_number": "801-587-6470",
"fax_number": "801-585-5629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 N MEDICAL DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841320001",
"telephone_number": "801-581-2121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIBBLE",
"first_name": "LELAND",
"middle_name": "E",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2007-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "UT",
"license": "93-264888-2401",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD ID",
"identifier": "26488824000001",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.