MEDICARE: DEBORAH HODGINS PTA

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	225200000X	Physical Therapy Assistant	2105430	TX

General Provider Information

NPI Number	:	1629539200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH HODGINS PTA

Provider Business Mailing Address
First Line	:	8038 EXCHANGE DR APT 412
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-4808
Country	:	US
Telephone Number	:	713-306-3812
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 W SLAUGHTER LN STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-1774
Country	:	US
Telephone Number	:	512-599-9180
Fax Number	:

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

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	03/27/2019

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