Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT007613L | PA |
N | 2251S0007X | Physical Therapist - Sports | PT007613L | PA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT007613L | PA |
NPI | 1275529836 |
---|---|
Provider Name | Vincent J. Hudson |
First Address | Boston, MA 02284-8269 |
Second Address | Allentown, PA 18104-9168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 31/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
091843 | MEDICARE (01) | PA |
1738936 | BLUE SHIELD (01) | PA |
1738936 | PERSONAL CHOICE (01) | PA |
2001780 | KEYSTONE CENTRAL (01) | PA |
4307918 | AETNA (01) | PA |
50050471 | BLUE CROSS (01) | PA |