Provider Demographics
NPI:1659555647
Name:LIUDAHL, DAVID WILLIAM (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WILLIAM
Last Name:LIUDAHL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1251
Mailing Address - Country:US
Mailing Address - Phone:913-884-6755
Mailing Address - Fax:913-884-6756
Practice Address - Street 1:611 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1251
Practice Address - Country:US
Practice Address - Phone:913-884-6755
Practice Address - Fax:913-884-6756
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02829172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist