=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154630036
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN D DODGE ATC, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2010
-----------------------------------------------------
Last Update Date | 04/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 164 MILAN AVE
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44857-1146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-660-0876
-----------------------------------------------------
Fax | 419-660-9104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 378
-----------------------------------------------------
City | SANDUSKY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44871-0378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-626-6161
-----------------------------------------------------
Fax | 419-502-3511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | AT.002987
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | PT.012923
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------