MEDICARE: CASSIE DAHLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MAS-2880	ID

General Provider Information

NPI Number	:	1639049505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE DAHLE

Provider Business Mailing Address
First Line	:	646 SYRINGA SPRINGS DR
Second Line	:
City	:	FRUITLAND
State	:	ID
Zip	:	83619-5016
Country	:	US
Telephone Number	:	208-569-1062
Fax Number	:

Provider Business Practice Location Address
First Line	:	646 SYRINGA SPRINGS DR
Second Line	:
City	:	FRUITLAND
State	:	ID
Zip	:	83619-5016
Country	:	US
Telephone Number	:	208-569-1062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	11/06/2025

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Directions to “ CASSIE DAHLE ” Practice Location

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