Provider Demographics
NPI:1184642373
Name:DAHL, THOMAS LEONARD II (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LEONARD
Last Name:DAHL
Suffix:II
Gender:M
Credentials:PT
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15700 37TH AVE N STE 220
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3399
Mailing Address - Country:US
Mailing Address - Phone:651-968-5201
Mailing Address - Fax:
Practice Address - Street 1:15700 37TH AVE N STE 220
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446
Practice Address - Country:US
Practice Address - Phone:651-968-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1184642373OtherCIGNA