Provider Demographics
NPI:1790995892
Name:WAYNE C DODD
Entity Type:Organization
Organization Name:WAYNE C DODD
Other - Org Name:ISLA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DODD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-546-7777
Mailing Address - Street 1:495 AMELIA EARHART DR STE B
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-5771
Mailing Address - Country:US
Mailing Address - Phone:956-546-7777
Mailing Address - Fax:956-546-8899
Practice Address - Street 1:495 AMELIA EARHART STE B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521
Practice Address - Country:US
Practice Address - Phone:956-546-7777
Practice Address - Fax:956-546-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1064996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0065GTOtherBLUE CROSS BLUE SHIELD
TX142452501Medicaid
TX142452501Medicaid