Provider Demographics
NPI:1457679623
Name:DODSON, TODD J (MPT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:J
Last Name:DODSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 8TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1028
Mailing Address - Country:US
Mailing Address - Phone:515-967-0133
Mailing Address - Fax:515-967-7578
Practice Address - Street 1:2720 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1028
Practice Address - Country:US
Practice Address - Phone:515-957-8609
Practice Address - Fax:515-957-9264
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA719260378Medicare PIN