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General NPI Number Information
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NPI Number | 1932546587
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Entity Type | Individual
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Provider Name | KERI DAHLSTROM
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Gender | Female
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 351 PROVIDENCE MINE RD
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City | NEVADA CITY
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State | CA
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Zip | 95959-2980
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Country | US
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Telephone | 530-263-6974
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Fax | 530-362-4640
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Provider Business Mailing Address
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Address Line | 12535 MADRONE FOREST DR
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City | NEVADA CITY
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State | CA
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Zip | 95959-9673
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Country | US
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Telephone | 530-477-6330
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT23063
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 23063
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License Number State | CA
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