Healthcare Provider Details

I. General information

NPI: 1508973165
Provider Name (Legal Business Name): JASON PAUL HODDE MS, ATC/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 INNOVATION PLACE
WEST LAFAYETTE IN
47906
US

IV. Provider business mailing address

912 LINDBERG RD
WEST LAFAYETTE IN
47906-2012
US

V. Phone/Fax

Practice location:
  • Phone: 765-497-3355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number36000176A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number36000176A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: