Healthcare Provider Details

I. General information

NPI: 1922665934
Provider Name (Legal Business Name): DAHLE PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 SHOUP ST.
SALMON ID
83467-4305
US

IV. Provider business mailing address

812 SHOUP ST.
SALMON ID
83467-4305
US

V. Phone/Fax

Practice location:
  • Phone: 208-940-2170
  • Fax:
Mailing address:
  • Phone: 208-940-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNAH BENEDICT DAHLE
Title or Position: OWNER
Credential: DPT
Phone: 208-940-2170