Provider Demographics
NPI:1124261037
Name:DODSON, SHAUN PHILIP (DPT)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:PHILIP
Last Name:DODSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 RIVERSIDE PLAZA LN NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2617
Mailing Address - Country:US
Mailing Address - Phone:337-344-1069
Mailing Address - Fax:
Practice Address - Street 1:1391 TIFFANY LN SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-0997
Practice Address - Country:US
Practice Address - Phone:337-344-1069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist