Provider Demographics
NPI:1689997769
Name:DAHL, KATHERINE BAUER (DPT)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:BAUER
Last Name:DAHL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5677 OBERLIN DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1741
Mailing Address - Country:US
Mailing Address - Phone:858-457-8419
Mailing Address - Fax:
Practice Address - Street 1:5677 OBERLIN DR STE 106
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1741
Practice Address - Country:US
Practice Address - Phone:858-457-8419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist