Provider Demographics
NPI:1548329667
Name:DODSON, MARK G (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:DODSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 LA SIERRA DR
Mailing Address - Street 2:#204
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4139
Mailing Address - Country:US
Mailing Address - Phone:214-692-6666
Mailing Address - Fax:214-692-6670
Practice Address - Street 1:5445 LA SIERRA DR
Practice Address - Street 2:#204
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4139
Practice Address - Country:US
Practice Address - Phone:214-692-6666
Practice Address - Fax:214-692-6670
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist