Provider Demographics
NPI:1518936764
Name:DAHL, ROXANN M (ATC)
Entity Type:Individual
Prefix:MISS
First Name:ROXANN
Middle Name:M
Last Name:DAHL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 SKYNOB DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2512
Mailing Address - Country:US
Mailing Address - Phone:734-669-4324
Mailing Address - Fax:
Practice Address - Street 1:1955 W PARNALL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8658
Practice Address - Country:US
Practice Address - Phone:847-702-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer