MEDICARE: MRS. BRIANNA DODRER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	A4235	MD

General Provider Information

NPI Number	:	1396497053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIANNA DODRER

Provider Business Mailing Address
First Line	:	6109 MIDDLEBURG RD
Second Line	:
City	:	KEYMAR
State	:	MD
Zip	:	21757-9125
Country	:	US
Telephone Number	:	410-596-1735
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 E BALTIMORE ST STE 103
Second Line	:
City	:	TANEYTOWN
State	:	MD
Zip	:	21787-2279
Country	:	US
Telephone Number	:	410-848-8628
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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