Provider Demographics
NPI:1093799629
Name:HODGE, WENDY W (MPT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:W
Last Name:HODGE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 WASHINGTON ST
Mailing Address - Street 2:STE 200
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-5709
Mailing Address - Country:US
Mailing Address - Phone:774-696-8309
Mailing Address - Fax:508-497-9201
Practice Address - Street 1:65 SOUTH ST STE 101
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-2234
Practice Address - Country:US
Practice Address - Phone:508-721-0000
Practice Address - Fax:508-497-9201
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8329225100000X
MA22936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist