Provider Demographics
NPI:1962899401
Name:DODGE, CINDY C (RPT)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:C
Last Name:DODGE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ROXBURY RD.
Mailing Address - Street 2:CHATHAM PHYSICAL THERAPY
Mailing Address - City:CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12037
Mailing Address - Country:US
Mailing Address - Phone:518-392-7173
Mailing Address - Fax:
Practice Address - Street 1:5 ROXBURY RD.
Practice Address - Street 2:CHATHAM PHYSICAL THERAPY
Practice Address - City:CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12037
Practice Address - Country:US
Practice Address - Phone:518-392-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006078-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist