Martin Dale Hodges
Individual provider Active NPI Physical Therapist · Republic, MO
NPI 1013539048 · NPPES record last updated May 13, 2020
Key facts
- NPI
- 1013539048
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2005010778 (MO)
- Practice address
- 830 S Illinois Ave
Republic, MO 65738-1177 - Phone
- (417) 269-1900
- Fax
- (417) 269-1904
- NPI assigned
- May 13, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005010778 | MO | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lester E Cox Medical Centers | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2005010778 | MO | Yes |
Addresses
Primary practice location
830 S Illinois Ave
Republic, MO 65738-1177
Mailing address
830 S Illinois Ave
Republic, MO 65738-1177
Phone (417) 269-1900
Other providers in Republic, MO
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- Hines Street Pharmacy 2 LLC
- Hines Street Pharmacy LLC
- Hines Street Pharmacy LLC
- Amanda S Hoge
- Alexandria Paige Holmes
- Drew Holtz
- Sharon Igou
- J&J King Investments, Inc
All providers in Republic, MO · Physical Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.