Provider Demographics
NPI:1790576635
Name:HODDER, MARYSSA REBECCA
Entity type:Individual
Prefix:
First Name:MARYSSA
Middle Name:REBECCA
Last Name:HODDER
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 N 7TH ST APT 429
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18101-1370
Mailing Address - Country:US
Mailing Address - Phone:609-444-6889
Mailing Address - Fax:
Practice Address - Street 1:153 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8931
Practice Address - Country:US
Practice Address - Phone:484-526-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics