Provider Demographics
NPI:1962477802
Name:HODGES, BENITA JO DOUGHTY (PT)
Entity Type:Individual
Prefix:MRS
First Name:BENITA
Middle Name:JO DOUGHTY
Last Name:HODGES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7935
Mailing Address - Country:US
Mailing Address - Phone:270-781-5150
Mailing Address - Fax:270-781-2392
Practice Address - Street 1:303 LOVERS LN
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7935
Practice Address - Country:US
Practice Address - Phone:270-781-5150
Practice Address - Fax:270-781-2392
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1715225100000X
KY002893225100000X
TN0000002608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist