MEDICARE: TROY HODGES PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	P1 60171623	WA

General Provider Information

NPI Number	:	1306146428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROY HODGES PTA

Provider Business Mailing Address
First Line	:	110 S BLUE ST
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2440
Country	:	US
Telephone Number	:	509-944-1418
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 W TIETAN ST
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-4363
Country	:	US
Telephone Number	:	509-522-0114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2010
Last Update Date	:	10/22/2010

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