Basic Information
| Provider Information | |||||||||
| NPI: | 1144599663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HODRICK | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | SUSAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1009 BROAD STREET | ||||||||
| Address2: | |||||||||
| City: | MONTOURSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703688389 | ||||||||
| FaxNumber: | 5703688391 | ||||||||
| Practice Location | |||||||||
| Address1: | 1009 BROAD STREET | ||||||||
| Address2: | |||||||||
| City: | MONTOURSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703688389 | ||||||||
| FaxNumber: | 5703688391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2011 | ||||||||
| LastUpdateDate: | 12/29/2011 | ||||||||
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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 | 225700000X | MSG002182 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.