Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 8121 | MN |
NPI | 1003079963 |
---|---|
Provider Name | Mrs. Allison Lydia Dahl |
First Address | Minneapolis, MN 55448-2467 |
Second Address | Minneapolis, MN 55417-2300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 09/07/2008 |