MEDICARE: DIANE HODGES POPPS PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	1218117	TX
2	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1218117	OTHER	TX	TEXAS BOARD OF PHYSICAL THERAPY

General Provider Information

NPI Number	:	1154730091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE HODGES POPPS PT, DPT

Provider Business Mailing Address
First Line	:	1033 LA POSADA DR STE 308
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78752-3824
Country	:	US
Telephone Number	:	512-284-7192
Fax Number	:

Provider Business Practice Location Address
First Line	:	6911 RR 620 N STE B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-1920
Country	:	US
Telephone Number	:	512-467-4546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2014
Last Update Date	:	06/06/2022

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