Provider Demographics
NPI:1295039543
Name:DODSON, DIANNE L (CPTA)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:L
Last Name:DODSON
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S PROSPECT PL
Mailing Address - Street 2:P.O. BOX 191
Mailing Address - City:BURLINGAME
Mailing Address - State:KS
Mailing Address - Zip Code:66413-1525
Mailing Address - Country:US
Mailing Address - Phone:785-654-3748
Mailing Address - Fax:
Practice Address - Street 1:510 S PROSPECT PL
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:KS
Practice Address - Zip Code:66413-1525
Practice Address - Country:US
Practice Address - Phone:785-654-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-00267225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant