Healthcare Provider Details

I. General information

NPI: 1629179825
Provider Name (Legal Business Name): JEFFREY MICHAEL HODER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 W BROAD ST
RICHMOND VA
23230-1714
US

IV. Provider business mailing address

9150 KINGS CHARTER DR
MECHANICSVILLE VA
23116-5195
US

V. Phone/Fax

Practice location:
  • Phone: 804-662-9185
  • Fax: 804-662-9178
Mailing address:
  • Phone: 201-723-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT008789
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2305207237
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: