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General NPI Number Information
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NPI Number | 1013280007
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Entity Type | Individual
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Provider Name | BRANDI JEAN DOGODA PTA
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Gender | Female
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 626 N TYNDALL PKWY
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City | CALLAWAY
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State | FL
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Zip | 32404-6132
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Country | US
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Telephone | 850-871-3836
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Fax |
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Provider Business Mailing Address
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Address Line | 7208 LAKE SUZZANNE LN
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City | PANAMA CITY
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State | FL
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Zip | 32404-3410
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Country | US
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Telephone | 850-867-5737
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA20798
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License Number State | FL
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