MEDICARE: MS. KATHERINE BAUER DAHL DPT

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
1	225100000X	Physical Therapist	PT36469	CA

General Provider Information

NPI Number	:	1689997769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE BAUER DAHL DPT

Provider Business Mailing Address
First Line	:	5677 OBERLIN DR STE 106
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1741
Country	:	US
Telephone Number	:	858-457-8419
Fax Number	:

Provider Business Practice Location Address
First Line	:	5677 OBERLIN DR STE 106
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1741
Country	:	US
Telephone Number	:	858-457-8419
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	03/03/2010

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