Provider Demographics
NPI:1295252286
Name:HODGETTS, OLGA (DPT)
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:HODGETTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:WODAREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:53060 COUNTY MURRAY DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8992
Mailing Address - Country:US
Mailing Address - Phone:412-706-0436
Mailing Address - Fax:
Practice Address - Street 1:418 W CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-5638
Practice Address - Country:US
Practice Address - Phone:574-271-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020294225100000X
IN05012062A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05012062AMedicaid