Individual
MR. LELAND E DIBBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-2121
Mailing address
127 S 500 E, SUITE 660, SALT LAKE CITY, UT 84102-1959
(801) 587-6470
(801) 585-5629
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
93-264888-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26488824000001
BLUE CROSS BLUE SHIELD ID
UT
Enumeration date
08/29/2006
Last updated
08/20/2007
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