Provider Demographics
NPI:1508286402
Name:DODGE, PATRICE (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:
Last Name:DODGE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7139 PROVOST RD NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1195
Mailing Address - Country:US
Mailing Address - Phone:360-434-2951
Mailing Address - Fax:
Practice Address - Street 1:7139 PROVOST RD NW
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1195
Practice Address - Country:US
Practice Address - Phone:360-434-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000002990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist