Provider Demographics
NPI:1679112031
Name:HODGES, SUSAN JANE (PT, MLDT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:HODGES
Suffix:
Gender:F
Credentials:PT, MLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 W UNIVERSITY PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1618
Mailing Address - Country:US
Mailing Address - Phone:731-300-4950
Mailing Address - Fax:731-300-4951
Practice Address - Street 1:176 W UNIVERSITY PKWY STE E
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1618
Practice Address - Country:US
Practice Address - Phone:731-300-4950
Practice Address - Fax:731-300-4951
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000003326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist