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General NPI Number Information
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NPI Number | 1124261037
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Entity Type | Individual
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Provider Name | SHAUN PHILIP DODSON DPT
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Gender | Male
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 1391 TIFFANY LN SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-0997
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Country | US
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Telephone | 337-344-1069
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 RIVERSIDE PLAZA LN NW SUITE 100
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-2617
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Country | US
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Telephone | 337-344-1069
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3666
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License Number State | NM
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