Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251N0400X | Physical Therapist - Neurology | 1105807 | TX |
Y | 2251P0200X | Physical Therapist - Pediatrics | 1105807 | TX |
NPI | 1568564698 |
---|---|
Provider Name | Ms. Lauri Ann Dahl |
First Address | San Antonio, TX 78201-5159 |
Second Address | San Antonio, TX 78223-3506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 29/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8T4467 | BCBS (01) | TX |