Provider Demographics
NPI:1538411244
Name:HODGE, TORIN RICHARD (LMP)
Entity type:Individual
Prefix:
First Name:TORIN
Middle Name:RICHARD
Last Name:HODGE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 OLD REDMOND RD
Mailing Address - Street 2:F-124
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6840
Mailing Address - Country:US
Mailing Address - Phone:520-661-8789
Mailing Address - Fax:
Practice Address - Street 1:17214 REDMOND WAY
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4403
Practice Address - Country:US
Practice Address - Phone:425-558-9399
Practice Address - Fax:425-558-9439
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60292613225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist