Provider Demographics
NPI:1760531750
Name:DAHL, BRENDA L (MSPT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:DAHL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 RODEO DR STE 1
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6859
Mailing Address - Country:US
Mailing Address - Phone:406-273-9033
Mailing Address - Fax:406-273-0993
Practice Address - Street 1:293 RODEO DR STE 1
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6859
Practice Address - Country:US
Practice Address - Phone:406-273-9033
Practice Address - Fax:406-273-9033
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist