Provider Demographics
NPI:1447793740
Name:HODOUS, SAMUEL JON (PT)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JON
Last Name:HODOUS
Suffix:
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 1:2650 SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4204
Mailing Address - Country:US
Mailing Address - Phone:216-408-1230
Mailing Address - Fax:
Practice Address - Street 1:7797 W PARADISE LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5009
Practice Address - Country:US
Practice Address - Phone:623-486-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist