Healthcare Provider Details

I. General information

NPI: 1720132186
Provider Name (Legal Business Name): BENJAMIN VON HODGE BACHELORS OF PHYSICA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 MORRISON ROAD
COLUMBUS OH
43213
US

IV. Provider business mailing address

5688 BURNTWOOD WAY
WESTERVILLE OH
43081-6603
US

V. Phone/Fax

Practice location:
  • Phone: 614-868-1115
  • Fax: 614-863-9338
Mailing address:
  • Phone: 614-620-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010431
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: