Provider Demographics
NPI:1154578409
Name:HODGES, REGINA G
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:G
Last Name:HODGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:G
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:3141YOUNGERS CREEK RD.
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:KY
Mailing Address - Zip Code:40051
Mailing Address - Country:US
Mailing Address - Phone:502-549-6663
Mailing Address - Fax:
Practice Address - Street 1:106 DIECKS DRIVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-769-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA00185225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant