Provider Demographics
NPI:1801812599
Name:HODGES, JAMES DAVID (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DAVID
Last Name:HODGES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 MOUNT PLEASANT ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-2002
Mailing Address - Country:US
Mailing Address - Phone:319-754-6558
Mailing Address - Fax:319-754-6512
Practice Address - Street 1:2850 MOUNT PLEASANT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-2002
Practice Address - Country:US
Practice Address - Phone:319-754-6558
Practice Address - Fax:319-754-6512
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1080465Medicaid
IA23733OtherBLUE CROSS
IAI1346Medicare ID - Type Unspecified