Provider Demographics
NPI:1558669267
Name:HUDSON, SCOTT JOSEPH (MS, ATC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JOSEPH
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8227 NORTHWEST BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1386
Mailing Address - Country:US
Mailing Address - Phone:317-415-5743
Mailing Address - Fax:317-415-5747
Practice Address - Street 1:8227 NORTHWEST BLVD STE 160
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1386
Practice Address - Country:US
Practice Address - Phone:317-415-5743
Practice Address - Fax:317-415-5747
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001359A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer