Provider Demographics
NPI:1295372027
Name:WHOLEHEALTH PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:WHOLEHEALTH PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES-EARL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:714-608-3417
Mailing Address - Street 1:21123 VIA VENTURA
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2230
Mailing Address - Country:US
Mailing Address - Phone:714-608-3417
Mailing Address - Fax:
Practice Address - Street 1:21123 VIA VENTURA
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2230
Practice Address - Country:US
Practice Address - Phone:714-608-3417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty