Jean Dahlstrom, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1451024 Issued in WI

Practice address

617 S Roosevelt St
Green Bay, WI 54301-3402

Phone

(920) 445-7217

Fax

(920) 445-7229

NPI assigned

Apr 24, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bellin Memorial Hospital Inc

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1033172390

  Physical Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208995200000",
    "number": "1346415007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 S ROOSEVELT ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013402",
            "telephone_number": "920-445-7217",
            "fax_number": "920-445-7229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 S ROOSEVELT ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013402",
            "telephone_number": "920-445-7217",
            "fax_number": "920-445-7229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHLSTROM",
        "first_name": "JEAN",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-24",
        "last_updated": "2008-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "1451024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40186400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monica A Czachor, PT
• Christine Czechanski
• Anne Marie Czyz-Klemens, DMD
• D Bellmore Construction LLC
• Brooklyn Dachelet, MSW, CAPSW
• Mathias Dahnert, P.A.
• Wolfgang F Dahnert, MD
• Louis Alan Dainty, MD
• Charles F Dais II, M.D.
• Daniel L Dale, M.D.

• Physical Therapist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.