Provider Demographics
NPI:1265181358
Name:HODGE, RACHEL MARIE (LMT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:HODGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69222 1/2 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112
Mailing Address - Country:US
Mailing Address - Phone:269-259-1023
Mailing Address - Fax:
Practice Address - Street 1:69222 1/2 DAVIS ST
Practice Address - Street 2:
Practice Address - City:EDWARDSBURG
Practice Address - State:MI
Practice Address - Zip Code:49112
Practice Address - Country:US
Practice Address - Phone:269-259-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501011363225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist