Provider Demographics
NPI:1023535127
Name:HUDSON, DYLAN TODD (DPT)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:TODD
Last Name:HUDSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WINDWARD DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2174
Mailing Address - Country:US
Mailing Address - Phone:540-949-5383
Mailing Address - Fax:
Practice Address - Street 1:32 WINDWARD DR STE 110
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2174
Practice Address - Country:US
Practice Address - Phone:540-949-5383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist