| Doctor Name: | MR. COREY SHANE DAHL |
| NPI Number: | 1366578106 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, MPT, OCS |
| License Number: | 1116838 |
| Business Practice Address: | 29 Black Coal Drive Phs Indian Health Center Attn: Physical Therapy Dept. Fort Washakie, WY - 82514 |
| Business Phone Number: | 3073355935 |
| Business Fax Number: | |
| Mailing Address: | Po Box 128, Phs Indian Health Center Attn: Physical Therapy Dept. FORT WASHAKIE |
| State: | WY |
| Postal Code: | 82514 |
| Phone Number: | 3073355935 |
| Fax Number: | |
| NPI Enumeration Date: | 02/26/2007 |
| NPI Last Update Date: | 07/15/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1116838 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |