Provider Demographics
NPI:1124008180
Name:DAHL, CHRISTOPHER S (MPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:S
Last Name:DAHL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15909 JACKSON CREEK PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8693
Mailing Address - Country:US
Mailing Address - Phone:719-481-0899
Mailing Address - Fax:719-481-0897
Practice Address - Street 1:15909 JACKSON CREEK PKWY STE 105
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132
Practice Address - Country:US
Practice Address - Phone:719-481-0899
Practice Address - Fax:719-481-0897
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205880225100000X
CO0006781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0392740OtherMEDICAID WELFARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
7509675OtherAETNA US HEALTHCARE
Y68346OtherBLUE SHIELD HMO BLUE
MA0392740Medicaid
042472266OtherTHREE RIVERS
785950OtherMVP HEALTH CARE
Y68346OtherBLUE SHIELD INDEMNITY
042472266OtherONE HEALTH PLAN
Y68346OtherBLUE CARE ELECT
90547OtherFALLON COMMUNITY HEALTH P
Y69423OtherMEDICARE B
MAY69423Medicare ID - Type Unspecified