Provider Demographics
NPI:1720807944
Name:HODGES, REBEKAH L (LMT)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:L
Last Name:HODGES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1235
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:WA
Mailing Address - Zip Code:98610-1235
Mailing Address - Country:US
Mailing Address - Phone:509-310-3424
Mailing Address - Fax:
Practice Address - Street 1:40 SW CASCADE AVE
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-6284
Practice Address - Country:US
Practice Address - Phone:509-310-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60666241225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist