Provider Demographics
NPI:1629029939
Name:DOLBOW, DAVID ROGER (PHD, DPT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROGER
Last Name:DOLBOW
Suffix:
Gender:M
Credentials:PHD, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 NEW HOPE MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-4710
Mailing Address - Country:US
Mailing Address - Phone:615-225-4612
Mailing Address - Fax:
Practice Address - Street 1:4209 NEW HOPE MEADOW RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-4710
Practice Address - Country:US
Practice Address - Phone:615-225-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
226300000X
TN7978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist