Provider Demographics
NPI:1437181880
Name:HUDSON, JOHN L III (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:HUDSON
Suffix:III
Gender:M
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:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341
Mailing Address - Country:US
Mailing Address - Phone:864-487-7874
Mailing Address - Fax:864-487-7659
Practice Address - Street 1:1445 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340
Practice Address - Country:US
Practice Address - Phone:864-487-7874
Practice Address - Fax:864-487-7659
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0901Medicaid
SCTH0901Medicaid