Provider Demographics
NPI:1306076187
Name:DALLY, KARAN
Entity type:Individual
Prefix:
First Name:KARAN
Middle Name:
Last Name:DALLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-1332
Mailing Address - Country:US
Mailing Address - Phone:218-365-7840
Mailing Address - Fax:
Practice Address - Street 1:201 E BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1332
Practice Address - Country:US
Practice Address - Phone:218-365-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist