Provider Demographics
NPI:1407221146
Name:HUDSON, SARAH (ATC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:BOTHOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:432 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:WEYERS CAVE
Mailing Address - State:VA
Mailing Address - Zip Code:24486-2704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:368 BLAZER DR
Practice Address - Street 2:
Practice Address - City:PENN LAIRD
Practice Address - State:VA
Practice Address - Zip Code:22846-9551
Practice Address - Country:US
Practice Address - Phone:540-289-3100
Practice Address - Fax:540-289-3301
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260021752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer