Provider Demographics
NPI:1932432887
Name:DODGE, JAKE ARNOLD (DPT)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:ARNOLD
Last Name:DODGE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19235 15TH AVE NW
Mailing Address - Street 2:RICHMOND BEACH REHABILITATION AND SPECIALTY CARE
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177
Mailing Address - Country:US
Mailing Address - Phone:206-546-2666
Mailing Address - Fax:
Practice Address - Street 1:19235 15TH AVE NW
Practice Address - Street 2:RICHMOND BEACH REHABILITATION AND SPECIALTY CARE
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177
Practice Address - Country:US
Practice Address - Phone:206-546-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPU60095969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist