Provider Demographics
NPI:1902671837
Name:DAHL, MIKAELA KARIN (DPT)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:KARIN
Last Name:DAHL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 ROBB DR STE D5
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-3520
Mailing Address - Country:US
Mailing Address - Phone:775-746-9222
Mailing Address - Fax:775-746-9224
Practice Address - Street 1:1610 ROBB DR STE D5
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-3520
Practice Address - Country:US
Practice Address - Phone:775-746-9222
Practice Address - Fax:775-746-9224
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist