Active NPI
Daryl L Dodd
- Physical Therapist
- Anaconda, MT
National Provider Identifier
1063669745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 102PT
- Practice address
- 401 W Pennsylvania St
Anaconda, MT 59711-1931 - Phone
- (406) 563-8590
- Fax
- (406) 563-8565
- NPI assigned
- Aug 25, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 102PT | MT | Primary |
Addresses
Primary practice location
401 W Pennsylvania St
Anaconda, MT 59711-1931
Mailing address
401 W Pennsylvania St
Anaconda, MT 59711-1931
Phone (406) 563-8590
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102PT | Other | MT | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102PT | MT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219622400000",
"number": "1063669745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 W PENNSYLVANIA ST",
"city": "ANACONDA",
"state": "MT",
"postal_code": "597111931",
"telephone_number": "406-563-8590",
"fax_number": "406-563-8565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 W PENNSYLVANIA ST",
"city": "ANACONDA",
"state": "MT",
"postal_code": "597111931",
"telephone_number": "406-563-8590",
"fax_number": "406-563-8565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DODD",
"first_name": "DARYL",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-25",
"last_updated": "2008-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MT",
"license": "102PT",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "102PT",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anaconda, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.