Healthcare Provider Details

I. General information

NPI: 1992388045
Provider Name (Legal Business Name): RYAN PHILLIP HODGES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10315 HAMPTONS PARK DR
HUNTERSVILLE NC
28078-7217
US

IV. Provider business mailing address

4601 PARK RD STE 300
CHARLOTTE NC
28209-2290
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-2809
  • Fax: 704-323-3991
Mailing address:
  • Phone: 704-323-3611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP20325
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: