Provider Demographics
NPI:1316633308
Name:DAHLGREN, KAITLYN (DPT)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:DAHLGREN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 5TH AVE NE # 200
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-2205
Mailing Address - Country:US
Mailing Address - Phone:763-688-9750
Mailing Address - Fax:
Practice Address - Street 1:300 5TH AVE NE # 200
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-2205
Practice Address - Country:US
Practice Address - Phone:763-688-9750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist