Provider Demographics
NPI:1710169735
Name:DAHLSTEDT, SUSAN ANNETTE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNETTE
Last Name:DAHLSTEDT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 E RAY ROAD, SUITE 105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4311
Mailing Address - Country:US
Mailing Address - Phone:480-759-3778
Mailing Address - Fax:480-759-3779
Practice Address - Street 1:4350 E RAY RD STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4704
Practice Address - Country:US
Practice Address - Phone:480-759-3778
Practice Address - Fax:480-759-3779
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ78406Medicare PIN