Provider Demographics
NPI:1396936332
Name:HODNETT, DAVID ANDREW (DPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:HODNETT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:7650 E PARHAM RD
Practice Address - Street 2:SUITE100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4373
Practice Address - Country:US
Practice Address - Phone:804-282-6338
Practice Address - Fax:804-285-3237
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305000941225100000X
VA23052051372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1396936332Medicaid
VAP00466831OtherRAILROAD MEDICARE
VA1396936332Medicaid
VA0472640005Medicare NSC