Provider Demographics
NPI:1770896946
Name:DAHLQUIST, NELS R (RPT)
Entity type:Individual
Prefix:
First Name:NELS
Middle Name:R
Last Name:DAHLQUIST
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 SANTA ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-1360
Mailing Address - Country:US
Mailing Address - Phone:626-582-8812
Mailing Address - Fax:626-582-8713
Practice Address - Street 1:3236 SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1360
Practice Address - Country:US
Practice Address - Phone:626-582-8812
Practice Address - Fax:626-582-8713
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist