Provider Demographics
NPI:1215015433
Name:HUDSON, WENDI B (PT)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:B
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 KING PALM WAY
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2108
Mailing Address - Country:US
Mailing Address - Phone:941-748-9489
Mailing Address - Fax:941-746-5637
Practice Address - Street 1:4955 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5530
Practice Address - Country:US
Practice Address - Phone:941-748-9489
Practice Address - Fax:941-746-5637
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15574174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT15574OtherPT LICENSE