Provider Demographics
NPI:1972383115
Name:HODDER, KEVIN JAMES (PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:HODDER
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 1:2621 N MAIN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2920
Mailing Address - Country:US
Mailing Address - Phone:210-504-7152
Mailing Address - Fax:
Practice Address - Street 1:2621 N MAIN AVE STE E
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2920
Practice Address - Country:US
Practice Address - Phone:210-504-7152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1382646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist