Provider Demographics
NPI:1942848726
Name:DODSON, ASHLEY LOUISE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LOUISE
Last Name:DODSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 IRON MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-9019
Mailing Address - Country:US
Mailing Address - Phone:870-314-3257
Mailing Address - Fax:
Practice Address - Street 1:2721 IRON MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-9019
Practice Address - Country:US
Practice Address - Phone:870-314-3257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR903881822Medicaid