Provider Demographics
NPI:1801809413
Name:DODSON, WILLIAM H (PT, DSC, OCS, CHT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:H
Last Name:DODSON
Suffix:
Gender:M
Credentials:PT, DSC, OCS, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4504
Mailing Address - Country:US
Mailing Address - Phone:432-580-3300
Mailing Address - Fax:432-580-0505
Practice Address - Street 1:701 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4504
Practice Address - Country:US
Practice Address - Phone:432-580-3300
Practice Address - Fax:432-580-0505
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1072692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105319100OtherFIRSTCARE
TX144906801OtherMEDICAID DME
TX062884401Medicaid
TX83325TOtherBLUE CROSS BLUE SHIELD
TX0060DLOtherBLUE CROSS BLUE SHIELD
TX752617756OtherTAX IDENTFICATION NUMBER
TX0060DLOtherBLUE CROSS BLUE SHIELD