Provider Demographics
NPI:1851405658
Name:DAHL, JAN MARY (MA PT)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:MARY
Last Name:DAHL
Suffix:
Gender:F
Credentials:MA PT
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Mailing Address - Street 1:11071 DOGWOOD ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448
Mailing Address - Country:US
Mailing Address - Phone:763-754-6760
Mailing Address - Fax:
Practice Address - Street 1:1800 2ND STREET NE
Practice Address - Street 2:A CHANCE TO GROW
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418
Practice Address - Country:US
Practice Address - Phone:612-706-5537
Practice Address - Fax:612-706-5555
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN5522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist