Provider Demographics
NPI:1083297196
Name:DODGE THERAPY LLC
Entity Type:Organization
Organization Name:DODGE THERAPY LLC
Other - Org Name:FYZICAL THERAPY AND BALANCE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-848-4011
Mailing Address - Street 1:16109 S FARRELL RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-8200
Mailing Address - Country:US
Mailing Address - Phone:847-848-4011
Mailing Address - Fax:
Practice Address - Street 1:16109 S FARRELL RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-8200
Practice Address - Country:US
Practice Address - Phone:847-848-4011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty