Provider Demographics
NPI:1710203831
Name:DAHL, COLEEN E (MSPT)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:E
Last Name:DAHL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:COLEEN
Other - Middle Name:E
Other - Last Name:SEARLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0248
Mailing Address - Country:US
Mailing Address - Phone:814-670-0534
Mailing Address - Fax:814-670-0653
Practice Address - Street 1:142 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:COCHRANTON
Practice Address - State:PA
Practice Address - Zip Code:16314-8640
Practice Address - Country:US
Practice Address - Phone:814-638-0238
Practice Address - Fax:814-638-0007
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007843L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026301850001Medicaid
12091886OtherCAQH
PA179982NJTMedicare PIN