Provider Demographics
NPI:1477953412
Name:HODAK, RANDALL J (PT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:J
Last Name:HODAK
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 1:918 YOUNGSTOWN WARREN RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4623
Mailing Address - Country:US
Mailing Address - Phone:330-505-1606
Mailing Address - Fax:330-505-2621
Practice Address - Street 1:918 YOUNGSTOWN WARREN RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4623
Practice Address - Country:US
Practice Address - Phone:330-505-1606
Practice Address - Fax:330-505-2621
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT.003339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist