Healthcare Provider Details

I. General information

NPI: 1629029939
Provider Name (Legal Business Name): DAVID ROGER DOLBOW PH.D., DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 NEW HOPE MEADOW RD
HERMITAGE TN
37076-4710
US

IV. Provider business mailing address

4209 NEW HOPE MEADOW RD
HERMITAGE TN
37076-4710
US

V. Phone/Fax

Practice location:
  • Phone: 615-225-4612
  • Fax:
Mailing address:
  • Phone: 615-225-4612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7978
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: