Provider Demographics
NPI:1487652376
Name:DODD PARDEE, JO ANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:JO ANNE
Middle Name:
Last Name:DODD PARDEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JO ANNE
Other - Middle Name:
Other - Last Name:MATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 ROUTE 22
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-3214
Mailing Address - Country:US
Mailing Address - Phone:845-855-5214
Mailing Address - Fax:845-855-1977
Practice Address - Street 1:145 ROUTE 22
Practice Address - Street 2:SUITE 201
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564-3214
Practice Address - Country:US
Practice Address - Phone:845-855-5214
Practice Address - Fax:845-855-1977
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007511-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q69811Medicare ID - Type Unspecified