Provider Demographics
NPI:1568287159
Name:HODOR, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HODOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 S DAVIE ST APT 212
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2857
Mailing Address - Country:US
Mailing Address - Phone:518-649-3741
Mailing Address - Fax:
Practice Address - Street 1:3518 DRAWBRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8432
Practice Address - Country:US
Practice Address - Phone:336-890-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6363225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant