Provider Demographics
NPI:1326312414
Name:DAHL, LUCY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:DAHL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:DAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:219 133RD ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6409
Mailing Address - Country:US
Mailing Address - Phone:810-513-2792
Mailing Address - Fax:
Practice Address - Street 1:4560 SE INTERNATIONAL WAY STE 101
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-4628
Practice Address - Country:US
Practice Address - Phone:971-206-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR602202251G0304X
WA612832942251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics