Provider Demographics
NPI:1154451029
Name:HODGKINSON, MARY CREAGER (LPT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CREAGER
Last Name:HODGKINSON
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 N NAVARRO ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3918
Mailing Address - Country:US
Mailing Address - Phone:361-582-4667
Mailing Address - Fax:367-582-4787
Practice Address - Street 1:2806 N NAVARRO ST
Practice Address - Street 2:SUITE K
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3937
Practice Address - Country:US
Practice Address - Phone:361-582-4667
Practice Address - Fax:367-582-4787
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1040434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82454TOtherBLUE CROSS BLUE SHIELD
TX0054256OtherBLUELINK
TX4411879OtherAETNA
TX4411879OtherAETNA