Provider Demographics
NPI:1144629296
Name:DAHL, KATELYN ELISE (DPT)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ELISE
Last Name:DAHL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:ELISE
Other - Last Name:PELTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7872 CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-8005
Mailing Address - Country:US
Mailing Address - Phone:952-448-9081
Mailing Address - Fax:952-448-9088
Practice Address - Street 1:5101 COUNTY ROAD 101
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4163
Practice Address - Country:US
Practice Address - Phone:952-512-2400
Practice Address - Fax:952-512-2409
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist