Provider Demographics
NPI:1356796056
Name:DAHL, CHRISTI LYNN (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTI
Middle Name:LYNN
Last Name:DAHL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CHRISTI
Other - Middle Name:
Other - Last Name:GREENSIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-0066
Mailing Address - Country:US
Mailing Address - Phone:253-261-8733
Mailing Address - Fax:
Practice Address - Street 1:27217 168TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360-9842
Practice Address - Country:US
Practice Address - Phone:253-835-5769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-01
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160031523225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant