MEDICARE: ISABEL CRISTINA HODGSON P.T.

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	2251X0800X	Orthopedic Physical Therapist	04380F	LA
2	225100000X	Physical Therapist	04380F	LA

General Provider Information

NPI Number	:	1548670151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABEL CRISTINA HODGSON P.T.

Provider Business Mailing Address
First Line	:	8448 SIEGEN LANE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-1938
Country	:	US
Telephone Number	:	225-767-8182
Fax Number	:	225-767-8757

Provider Business Practice Location Address
First Line	:	625 S BURNSIDE AVE
Second Line	:	UNIT 9
City	:	GONZALES
State	:	LA
Zip	:	70737-3400
Country	:	US
Telephone Number	:	225-644-8510
Fax Number	:	225-644-9736

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

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	12/02/2015

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Directions to “ ISABEL CRISTINA HODGSON P.T.” Practice Location

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