Provider Demographics
NPI:1679673073
Name:DAHLMAN, BRUCE GEORGE (PT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:GEORGE
Last Name:DAHLMAN
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 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:10961 CLUB WEST PKWY
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4671
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-528-2945
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16002255A2300X
MN6746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6405049OtherMEDICA
MN374L6DAOtherBCBS OF MN
MNHP47868OtherHEALTHPARTNERS
MN1250543OtherAMERICA'S PPO
MN374L6DAOtherBCBS OF MN