Provider Demographics
NPI:1649280785
Name:HODGES, LAURA S (RPT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:S
Last Name:HODGES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1099
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:FL
Mailing Address - Zip Code:32666-1099
Mailing Address - Country:US
Mailing Address - Phone:352-475-3113
Mailing Address - Fax:352-475-5796
Practice Address - Street 1:25727 NE SR 26
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:FL
Practice Address - Zip Code:32666
Practice Address - Country:US
Practice Address - Phone:352-475-3113
Practice Address - Fax:352-475-5796
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0002543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist