Provider Demographics
NPI:1932671682
Name:DAHLBERG, KARA LOUISE (LMT, CPT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LOUISE
Last Name:DAHLBERG
Suffix:
Gender:F
Credentials:LMT, CPT
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:LOUISE
Other - Last Name:SUPPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, CPT
Mailing Address - Street 1:4452 THRUSHFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-5624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 E 3RD ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1703
Practice Address - Country:US
Practice Address - Phone:810-206-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X, 225800000X
MI7501011321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist