Provider Demographics
NPI:1902497753
Name:DODD THERAPY CENTER LLC
Entity Type:Organization
Organization Name:DODD THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMISON
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:DODD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:601-590-1014
Mailing Address - Street 1:405 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-5545
Mailing Address - Country:US
Mailing Address - Phone:601-590-1014
Mailing Address - Fax:
Practice Address - Street 1:405 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-5545
Practice Address - Country:US
Practice Address - Phone:601-590-1014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy