Provider Demographics
NPI:1427069327
Name:DAHLGREN, HEIDI (LMT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:DAHLGREN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 JOSHUA BAKER RD
Mailing Address - Street 2:
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-3640
Mailing Address - Country:US
Mailing Address - Phone:727-207-3270
Mailing Address - Fax:508-534-9138
Practice Address - Street 1:572 ROUTE 28
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-4909
Practice Address - Country:US
Practice Address - Phone:727-207-3270
Practice Address - Fax:508-534-9138
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41432225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687645500Medicaid