Basic Information
| Provider Information | |||||||||
| NPI: | 1649761727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAHLE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1411 FALLS AVE E STE 415 | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833013455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089699945 | ||||||||
| FaxNumber: | 2089440448 | ||||||||
| Practice Location | |||||||||
| Address1: | 1615 CURLEW DR | ||||||||
| Address2: | |||||||||
| City: | AMMON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834064718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085161204 | ||||||||
| FaxNumber: | 2085776744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2018 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-5535 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT-5535 | 01 | ID | STATE LICENSE | OTHER |