Individual
MARK DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 WILLOW ST, PESHTIGO, WI 54157-1165
(715) 582-0144
(715) 582-0803
Mailing address
N1945 SHORE DR, MARINETTE, WI 54143-9213
(715) 732-0148
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2053
WI
Other
Enumeration date
05/27/2016
Last updated
05/27/2016
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