Basic Information
| Provider Information | |||||||||
| NPI: | 1548670151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HODGSON | ||||||||
| FirstName: | ISABEL | ||||||||
| MiddleName: | CRISTINA | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8448 SIEGEN LANE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708101938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257678182 | ||||||||
| FaxNumber: | 2257678757 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 S BURNSIDE AVE | ||||||||
| Address2: | UNIT 9 | ||||||||
| City: | GONZALES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707373400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256448510 | ||||||||
| FaxNumber: | 2256449736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2014 | ||||||||
| LastUpdateDate: | 12/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 04380F | LA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | 04380F | LA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.