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General NPI Number Information
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NPI Number | 1467384305
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Entity Type | Individual
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Provider Name | HARRISON IAN HODGE
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Gender | Male
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 925 N BRYAN BELT LINE RD
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City | MESQUITE
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State | TX
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Zip | 75149-2541
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Country | US
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Telephone | 972-681-1155
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Fax |
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Provider Business Mailing Address
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Address Line | 2165 TUCKER ST APT 2208
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City | DALLAS
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State | TX
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Zip | 75214-0190
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 1408403
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1408403
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1408403
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License Number State | TX
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