Individual
MR. TRAVIS DALE HODGSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
7501 GOODMAN RD, SUITE I, OLIVE BRANCH, MS 38654
(662) 890-3382
(662) 890-3385
Mailing address
9100 CHAMPLAIN DR, OLIVE BRANCH, MS 38654
(662) 893-7570
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA3566
MS
Other
Enumeration date
05/30/2006
Last updated
07/08/2007
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