Healthcare Provider Details

I. General information

NPI: 1902777030
Provider Name (Legal Business Name): LISA DAWN HODGES PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S 41ST ST E
MUSKOGEE OK
74403-6253
US

IV. Provider business mailing address

10149 W COUNTY ROAD 1170
STIGLER OK
74462-2743
US

V. Phone/Fax

Practice location:
  • Phone: 918-781-6500
  • Fax:
Mailing address:
  • Phone: 918-857-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1343
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: