Provider Demographics
NPI:1770895732
Name:DODGE, RHONDA CHRISTIAN (MPT)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:CHRISTIAN
Last Name:DODGE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S CHERRY ST
Mailing Address - Street 2:STE 1000
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1236
Mailing Address - Country:US
Mailing Address - Phone:303-536-5360
Mailing Address - Fax:303-536-5250
Practice Address - Street 1:425 SO CHERRY ST
Practice Address - Street 2:STE 640
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246
Practice Address - Country:US
Practice Address - Phone:303-333-3493
Practice Address - Fax:303-333-1184
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC500418Medicare UPIN