| Doctor Name: | MR. GLENN DODGE |
| NPI Number: | 1417021494 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPT |
| License Number: | 3474 |
| Business Practice Address: | 49 Nw 1st St Ste 1 Ontario, OR - 979142468 |
| Business Phone Number: | 5418894550 |
| Business Fax Number: | 5418894628 |
| Mailing Address: | 33648 Apple Valley Rd, PARMA |
| State: | ID |
| Postal Code: | 836606404 |
| Phone Number: | 2084841498 |
| Fax Number: | 5418894628 |
| NPI Enumeration Date: | 11/20/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 3474 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |