Provider Demographics
NPI:1154049427
Name:HODELL, ERIN KATHLEEN (DPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:KATHLEEN
Last Name:HODELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 RANDOLPH RD STE 105B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1365
Mailing Address - Country:US
Mailing Address - Phone:704-512-4420
Mailing Address - Fax:
Practice Address - Street 1:3030 RANDOLPH RD STE 105B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1365
Practice Address - Country:US
Practice Address - Phone:704-512-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11503225100000X
NCP22962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist