Provider Demographics
NPI:1972275972
Name:LODOWSKI, DYLAN JAMES (PT)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:JAMES
Last Name:LODOWSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 OLEAN RD APT 5
Mailing Address - Street 2:
Mailing Address - City:SOUTH WALES
Mailing Address - State:NY
Mailing Address - Zip Code:14139-9725
Mailing Address - Country:US
Mailing Address - Phone:716-220-2024
Mailing Address - Fax:
Practice Address - Street 1:655 S WILLOW ST STE 128
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5723
Practice Address - Country:US
Practice Address - Phone:800-995-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64685225100000X
WAPT61374006225100000X
NY047543225100000X
AK207443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist