Healthcare Provider Details

I. General information

NPI: 1407214216
Provider Name (Legal Business Name): TYLER DODSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 W EMELITA AVE
MESA AZ
85202-4034
US

IV. Provider business mailing address

711 N EVERGREEN RD APT 1098
MESA AZ
85201-7528
US

V. Phone/Fax

Practice location:
  • Phone: 877-407-3422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-012012
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: