Provider Demographics
NPI:1396082483
Name:HODGE, PAUL RICHARD (DPT)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:HODGE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3939 RUFFIN RD
Mailing Address - Street 2:STE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1802
Mailing Address - Country:US
Mailing Address - Phone:858-308-4185
Mailing Address - Fax:858-609-6651
Practice Address - Street 1:3939 RUFFIN RD
Practice Address - Street 2:STE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1802
Practice Address - Country:US
Practice Address - Phone:858-308-4185
Practice Address - Fax:858-609-6651
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT39528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB204703Medicare PIN
CAW17215Medicare PIN