Provider Demographics
NPI:1205549987
Name:DODD, AMY WILLINGHAM (MSPT, ATC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:WILLINGHAM
Last Name:DODD
Suffix:
Gender:F
Credentials:MSPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13904 TWIN CLIFFS LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-8006
Mailing Address - Country:US
Mailing Address - Phone:804-399-8680
Mailing Address - Fax:
Practice Address - Street 1:13904 TWIN CLIFFS LN
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-8006
Practice Address - Country:US
Practice Address - Phone:804-399-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist