Provider Demographics
NPI:1477178549
Name:HUDZIAK, MADHU MATSON (LMT)
Entity Type:Individual
Prefix:
First Name:MADHU
Middle Name:MATSON
Last Name:HUDZIAK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-8642
Mailing Address - Country:US
Mailing Address - Phone:360-661-3695
Mailing Address - Fax:
Practice Address - Street 1:221 2ND ST STE 15A
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-8664
Practice Address - Country:US
Practice Address - Phone:360-661-3695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-14
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA13458225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist