Provider Demographics
NPI:1346657657
Name:DODSON, KYRA
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:DODSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:SANDY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27046-7101
Mailing Address - Country:US
Mailing Address - Phone:336-618-6271
Mailing Address - Fax:
Practice Address - Street 1:1182 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:SANDY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27046-7101
Practice Address - Country:US
Practice Address - Phone:336-618-6271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer