Provider Demographics
NPI:1336680479
Name:HODOSH, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HODOSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66-150 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-1440
Mailing Address - Country:US
Mailing Address - Phone:808-799-7137
Mailing Address - Fax:808-356-1084
Practice Address - Street 1:66-150 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1440
Practice Address - Country:US
Practice Address - Phone:808-799-7137
Practice Address - Fax:808-356-1084
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI136225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant