Provider Demographics
NPI:1437175445
Name:HUDSON, WILLIAM HOWARD (RPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HOWARD
Last Name:HUDSON
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E VIRGINIA WAY
Mailing Address - Street 2:SUITE N
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-3978
Mailing Address - Country:US
Mailing Address - Phone:760-256-9243
Mailing Address - Fax:
Practice Address - Street 1:705 E VIRGINIA WAY
Practice Address - Street 2:SUITE N
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3978
Practice Address - Country:US
Practice Address - Phone:760-256-9243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT100693Medicare PIN