Provider Demographics
NPI:1871130740
Name:HODGESON, KATRINA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:HODGESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:HODGESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1085 S LINDEN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3416
Mailing Address - Country:US
Mailing Address - Phone:810-262-2000
Mailing Address - Fax:810-230-3366
Practice Address - Street 1:1085 S LINDEN RD STE 100
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3416
Practice Address - Country:US
Practice Address - Phone:810-262-2000
Practice Address - Fax:810-230-3366
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI00005502004331225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician