Provider Demographics
NPI:1558544197
Name:HODGES, JONATHAN JAMES (DPT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:JAMES
Last Name:HODGES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:653 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2808
Mailing Address - Country:US
Mailing Address - Phone:949-496-0122
Mailing Address - Fax:949-496-5027
Practice Address - Street 1:653 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2808
Practice Address - Country:US
Practice Address - Phone:949-496-0122
Practice Address - Fax:949-496-5027
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA342602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic