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General NPI Number Information
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NPI Number | 1699450510
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Entity Type | Individual
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Provider Name | ERIC A DAHL LMT, ACMT
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Gender | Male
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 32 UNION SQ E APT 41
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City | NEW YORK
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State | NY
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Zip | 10003-3209
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Country | US
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Telephone | 838-777-7517
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Fax |
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Provider Business Mailing Address
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Address Line | 609A WALTON RD
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City | BROAD CHANNEL
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State | NY
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Zip | 11693-1043
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Country | US
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Telephone | 646-286-2814
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 010599
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License Number State | NY
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