Provider Demographics
NPI:1316067630
Name:HODDE, MEGAN PORTERFIELD (LAT, ATC)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:PORTERFIELD
Last Name:HODDE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14332 CROWN HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7371
Mailing Address - Country:US
Mailing Address - Phone:704-577-6852
Mailing Address - Fax:
Practice Address - Street 1:2001 GASTON DAY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-7514
Practice Address - Country:US
Practice Address - Phone:704-864-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer