Healthcare Provider Details

I. General information

NPI: 1174717169
Provider Name (Legal Business Name): AMANDA HODDER CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY HODDER CMT

II. Dates (important events)

Enumeration Date: 09/01/2007
Last Update Date: 09/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10385 W WARREN DR
LAKEWOOD CO
80227-2046
US

IV. Provider business mailing address

10385 W WARREN DR
LAKEWOOD CO
80227-2046
US

V. Phone/Fax

Practice location:
  • Phone: 303-437-2510
  • Fax:
Mailing address:
  • Phone: 303-437-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: