Provider Demographics
NPI:1235969387
Name:DAHLQUIST, JAYSON (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAYSON
Middle Name:
Last Name:DAHLQUIST
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4593 CTH P
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-8240
Mailing Address - Country:US
Mailing Address - Phone:715-493-0558
Mailing Address - Fax:
Practice Address - Street 1:4593 CTH P
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-8240
Practice Address - Country:US
Practice Address - Phone:715-493-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16655-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist