Healthcare Provider Details

I. General information

NPI: 1285827436
Provider Name (Legal Business Name): TERRA C HODGES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8289 STEWARD CT
SPRING HILL FL
34608-6851
US

IV. Provider business mailing address

8289 STEWARD CT
SPRING HILL FL
34608-6851
US

V. Phone/Fax

Practice location:
  • Phone: 352-585-6395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA18578
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: