MEDICARE: HARRISON IAN HODGE

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	2251S0007X	Sports Physical Therapist	1408403	TX
2	2251X0800X	Orthopedic Physical Therapist	1408403	TX
3	225100000X	Physical Therapist	1408403	TX

General Provider Information

NPI Number	:	1467384305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRISON IAN HODGE

Provider Business Mailing Address
First Line	:	2165 TUCKER ST APT 2208
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-0190
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 N BRYAN BELT LINE RD
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-2541
Country	:	US
Telephone Number	:	972-681-1155
Fax Number	:

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

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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Directions to “ HARRISON IAN HODGE ” Practice Location

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