Provider Demographics
NPI:1275427072
Name:HODGE, KENNADI
Entity type:Individual
Prefix:
First Name:KENNADI
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 OAKLAND BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4300
Mailing Address - Country:US
Mailing Address - Phone:925-289-9750
Mailing Address - Fax:925-233-3444
Practice Address - Street 1:1407 OAKLAND BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4300
Practice Address - Country:US
Practice Address - Phone:925-289-9750
Practice Address - Fax:925-233-3444
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82156172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist