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NPI Code Detail

MEDICARE: DUSTIN DOUGLAS DAHLBERG DPT, PT

MEDICARE: DUSTIN DOUGLAS DAHLBERG DPT, PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT40858CA

General Provider Information

NPI Number : 1255742029
Entity Type Code : Individual
Provider Name (Legal Business Name) : DUSTIN DOUGLAS DAHLBERG DPT, PT
Provider Business Mailing Address
First Line : 3385 B ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-2427
Country : US
Telephone Number : 714-390-0753
Fax Number :
Provider Business Practice Location Address
First Line : 1201 34TH ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-2416
Country : US
Telephone Number : 619-232-2946
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2014
Last Update Date : 01/12/2015

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