MEDICARE: MCKENNA K DAHLGRIN DPT, MBA

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	225100000X	Physical Therapist	2023006442	MO

General Provider Information

NPI Number	:	1649044934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENNA K DAHLGRIN DPT, MBA

Provider Business Mailing Address
First Line	:	3007 N BELT HWY STE L
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-1557
Country	:	US
Telephone Number	:	402-410-1222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3007 N BELT HWY STE L
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-1557
Country	:	US
Telephone Number	:	402-410-1222
Fax Number	:

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

Provider Enumeration Date	:	11/08/2023
Last Update Date	:	01/20/2025

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