Provider Demographics
NPI:1720050008
Name:DODSON, ERIC J (MPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:DODSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ESTERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-4001
Mailing Address - Country:US
Mailing Address - Phone:856-751-8899
Mailing Address - Fax:856-751-1075
Practice Address - Street 1:5 ESTERBROOK LN
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-4001
Practice Address - Country:US
Practice Address - Phone:856-751-8899
Practice Address - Fax:856-751-1075
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00979200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
060115PMZMedicare ID - Type Unspecified