Basic Information
| Provider Information | |||||||||
| NPI: | 1912478751 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HODGES | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | BUCK | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2988 BLACKWATER CREEK DR | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338102673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636607101 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7350 DAIRY RD | ||||||||
| Address2: | |||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335401354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137884300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2018 | ||||||||
| LastUpdateDate: | 12/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA28841 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.