Provider Demographics
NPI:1790204881
Name:DAHLE, ANNAH BENEDICT (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANNAH
Middle Name:BENEDICT
Last Name:DAHLE
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 1:812 SHOUP ST
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-4305
Mailing Address - Country:US
Mailing Address - Phone:208-940-2170
Mailing Address - Fax:208-756-2354
Practice Address - Street 1:PORGY & PETUNIA'S PEDIATRIC THERAPY 111 E LILLIAN
Practice Address - Street 2:SUITE 8
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467
Practice Address - Country:US
Practice Address - Phone:208-940-2170
Practice Address - Fax:208-756-2354
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-4060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty