Provider Demographics
NPI:1417956392
Name:HODGES, PAUL A (PT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:HODGES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 W DUVAL RD
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-4207
Mailing Address - Country:US
Mailing Address - Phone:520-648-3132
Mailing Address - Fax:520-648-1861
Practice Address - Street 1:155 W DUVAL RD
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4207
Practice Address - Country:US
Practice Address - Phone:520-648-3132
Practice Address - Fax:520-648-1861
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012988225100000X
AZ9306225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ663966Medicaid
AZZ150421Medicare PIN
AZ663966Medicaid