Provider Demographics
NPI:1013611664
Name:DODARD, LASHANDRA (PTA)
Entity Type:Individual
Prefix:
First Name:LASHANDRA
Middle Name:
Last Name:DODARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LASHANDRA
Other - Middle Name:
Other - Last Name:BRINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:308 LAKE DAVENPORT CIR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7528
Mailing Address - Country:US
Mailing Address - Phone:747-238-2481
Mailing Address - Fax:
Practice Address - Street 1:40124 US-27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837
Practice Address - Country:US
Practice Address - Phone:863-419-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA32631225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant