MEDICARE: DR. KEVIN PATRICK DOLAN

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	225100000X	Physical Therapist	1339566	TX

General Provider Information

NPI Number	:	1952075566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN PATRICK DOLAN

Provider Business Mailing Address
First Line	:	10517 PLUMWOOD PKWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-0027
Country	:	US
Telephone Number	:	214-534-1115
Fax Number	:

Provider Business Practice Location Address
First Line	:	8708 MEDICAL CITY WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-2414
Country	:	US
Telephone Number	:	817-514-0519
Fax Number	:

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

Provider Enumeration Date	:	08/06/2021
Last Update Date	:	08/06/2021

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