Provider Demographics
NPI:1457443566
Name:DODD, HOLLY (MPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:DODD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 DAVIDSON LN
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22824-2617
Mailing Address - Country:US
Mailing Address - Phone:540-984-4914
Mailing Address - Fax:
Practice Address - Street 1:480 S COMMERCE AVE STE F
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3093
Practice Address - Country:US
Practice Address - Phone:540-636-3500
Practice Address - Fax:540-636-3502
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA102809OtherBCBS AQUATIC
VA388826OtherMAMSI
VA4576361OtherAETNA
VA150718500OtherDEPT OF LABOR
VA194082OtherBCBS GROUP # FR
VA541966445OtherUHC
VA16040OtherCOMMUNITY HEALTH
VA142752OtherBCBS INDIVIDUAL
VA194085OtherBCBS GROUP # WS
VA541966445OtherSOUTHERN HEALTH
VA194083OtherBCBS GROUP # WI
VA541966445OtherFIRST HEALTH
VA102809OtherBCBS AQUATIC
VA194082OtherBCBS GROUP # FR
VAC06487Medicare ID - Type UnspecifiedGROUP #