Provider Demographics
NPI:1568995777
Name:HODGES, ADRIANNE (PT, MS)
Entity Type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 W DANFORTH RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4803
Mailing Address - Country:US
Mailing Address - Phone:405-396-8000
Mailing Address - Fax:
Practice Address - Street 1:1271 W DANFORTH RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-4803
Practice Address - Country:US
Practice Address - Phone:405-396-8000
Practice Address - Fax:405-726-8181
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT30302251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200702590AMedicaid