Provider Demographics
NPI:1922150465
Name:WEBSTER-DAHL, LORI L (PT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:L
Last Name:WEBSTER-DAHL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8560 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LISBON
Mailing Address - State:WI
Mailing Address - Zip Code:53950-9185
Mailing Address - Country:US
Mailing Address - Phone:608-548-5212
Mailing Address - Fax:
Practice Address - Street 1:610 MCEVOY ST
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-1438
Practice Address - Country:US
Practice Address - Phone:608-548-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4953-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40457700Medicaid