Provider Demographics
NPI:1588768022
Name:DYBDAHL, CHAD RYAN (ATC)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:RYAN
Last Name:DYBDAHL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 W WIND DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6429
Mailing Address - Country:US
Mailing Address - Phone:770-717-8867
Mailing Address - Fax:
Practice Address - Street 1:1575 INDIAN TRAIL LILBURN RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2614
Practice Address - Country:US
Practice Address - Phone:770-243-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0005322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer