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NPI Code Detail

MEDICARE: BRANDI JEAN DOGODA PTA

MEDICARE: BRANDI JEAN DOGODA PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantPTA20798FL

General Provider Information

NPI Number : 1013280007
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDI JEAN DOGODA PTA
Provider Business Mailing Address
First Line : 7208 LAKE SUZZANNE LN
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-3410
Country : US
Telephone Number : 850-867-5737
Fax Number :
Provider Business Practice Location Address
First Line : 626 N TYNDALL PKWY
Second Line :
City : CALLAWAY
State : FL
Zip : 32404-6132
Country : US
Telephone Number : 850-871-3836
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2012
Last Update Date : 02/22/2012

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