Provider Demographics
NPI:1255989380
Name:DAHL, TESSA CHRISTINE (MA, ATC)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:CHRISTINE
Last Name:DAHL
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 ROADRUNNER DR
Mailing Address - Street 2:
Mailing Address - City:IONE
Mailing Address - State:CA
Mailing Address - Zip Code:95640-9752
Mailing Address - Country:US
Mailing Address - Phone:209-418-5144
Mailing Address - Fax:
Practice Address - Street 1:5151 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6304
Practice Address - Country:US
Practice Address - Phone:209-954-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other