Provider Demographics
NPI:1568564698
Name:DAHL, LAURI ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:LAURI
Middle Name:ANN
Last Name:DAHL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3031 W IH 10
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5159
Mailing Address - Country:US
Mailing Address - Phone:210-261-1000
Mailing Address - Fax:210-731-8678
Practice Address - Street 1:5802 S PRESA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3506
Practice Address - Country:US
Practice Address - Phone:210-261-3500
Practice Address - Fax:210-532-6090
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11058072251N0400X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4467OtherBCBS