Provider Demographics
NPI:1790497121
Name:WAHL, EMILY (PT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WAHL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-3708
Mailing Address - Country:US
Mailing Address - Phone:985-722-6545
Mailing Address - Fax:
Practice Address - Street 1:65 E WADSWORTH PARK DR STE 230
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8096
Practice Address - Country:US
Practice Address - Phone:985-722-6545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09771R225100000X
WYPT-2252225100000X
MN12999225100000X
IL070027562225100000X
MSPT7504225100000X
CA304245225100000X
NY050617225100000X
PAPT031377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist