=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598823288
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVE HODGSON RPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 11/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1255 LAS TABLAS RD STE 201
-----------------------------------------------------
City | TEMPLETON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93465-9750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-305-3270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1255 LAS TABLAS RD STE 201
-----------------------------------------------------
City | TEMPLETON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93465-9750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-305-3270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | PT28027
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------