Provider Demographics
NPI:1932302999
Name:DAHLMAN, KRISTINE LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:LYNN
Last Name:DAHLMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:LYNN
Other - Last Name:CAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7616 HARWOOD AVE
Mailing Address - Street 2:APT 301
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213
Mailing Address - Country:US
Mailing Address - Phone:414-453-1958
Mailing Address - Fax:
Practice Address - Street 1:19525 W NORTH AVENUE
Practice Address - Street 2:FRANCISCAN WOODS
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045
Practice Address - Country:US
Practice Address - Phone:262-780-3810
Practice Address - Fax:262-780-3805
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6270024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40319700Medicaid