Healthcare Provider Details

I. General information

NPI: 1669342655
Provider Name (Legal Business Name): LENEE DAHLGREN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 IDA RED
SPARTA MI
49345
US

IV. Provider business mailing address

2719 NORTHVALE DR NE APT 303
GRAND RAPIDS MI
49525-1789
US

V. Phone/Fax

Practice location:
  • Phone: 616-887-8152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502004269
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: