Healthcare Provider Details

I. General information

NPI: 1922174259
Provider Name (Legal Business Name): DAWN B DAHLEN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 SCOTSHIRE WAY SUITE 100
CUMMING GA
30040-7396
US

IV. Provider business mailing address

306 SPRUCE MANOR CT
CANTON GA
30114-9791
US

V. Phone/Fax

Practice location:
  • Phone: 678-206-6201
  • Fax: 678-206-6201
Mailing address:
  • Phone: 678-493-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5325
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: