Brock Justin Dodsworth, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2007031481 Issued in MO

Practice address

4430 Missouri Ave
Fort Leonard Wood, MO 65473-9098

Phone

(573) 596-1707

NPI assigned

Dec 24, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1230076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550016000000",
    "number": "1265678197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14939 TURKEY",
            "city": "SAINT ROBERT",
            "state": "MO",
            "postal_code": "655843718",
            "telephone_number": "660-349-7410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4430 MISSOURI AVE",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654739098",
            "telephone_number": "573-596-1707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODSWORTH",
        "first_name": "BROCK",
        "middle_name": "JUSTIN",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-24",
        "last_updated": "2019-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2007031481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Renee Dickow, LPCC
• Angela Renee Diebal-Lee, DPT, DSC, OCS, SCS
• Teresa Anne Distler, NP-C
• Nicholas Dobbs
• Kodjo Adam Dodo, RD
• Jessica Dolan, RDN
• Justin Marshall Dominguez, DPT
• Maria Mercedes Dominguez, PHD, LMFT
• Crystal Le-Ann Dornbach-Poojari, PHARM. D.
• Candice Renee Douglas, FNP-C

• Physical Therapy Assistant in Fort Leonard Wood, MO
• Providers in Fort Leonard Wood, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.