Provider Demographics
NPI:1841274230
Name:HODGES, JANE CAROLYN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:CAROLYN
Last Name:HODGES
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1331
Mailing Address - Country:US
Mailing Address - Phone:510-524-3857
Mailing Address - Fax:
Practice Address - Street 1:3718 GRAND AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1544
Practice Address - Country:US
Practice Address - Phone:510-589-3887
Practice Address - Fax:510-893-8879
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT263220Medicare ID - Type Unspecified