Provider Demographics
NPI:1043658743
Name:HODEL, EDWARD J IV (PT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:HODEL
Suffix:IV
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2988 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6229
Mailing Address - Country:US
Mailing Address - Phone:309-353-5940
Mailing Address - Fax:309-353-1654
Practice Address - Street 1:2988 COURT ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6229
Practice Address - Country:US
Practice Address - Phone:309-353-5940
Practice Address - Fax:309-353-1654
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist