Individual
JEAN DAHLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Contact information
Practice address
617 S ROOSEVELT ST, GREEN BAY, WI 54301-3402
(920) 445-7217
(920) 445-7229
Mailing address
617 S ROOSEVELT ST, GREEN BAY, WI 54301-3402
(920) 445-7217
(920) 445-7229
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1451024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40186400
—
WI
Enumeration date
04/24/2008
Last updated
04/24/2008
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