Provider Demographics
NPI:1578585535
Name:HUDSON, JANICE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:JANICE
Other - Middle Name:HUDSON
Other - Last Name:WETJEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MARRIED NAME
Mailing Address - Street 1:12142 175TH RD N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-4628
Mailing Address - Country:US
Mailing Address - Phone:561-512-6188
Mailing Address - Fax:561-744-7646
Practice Address - Street 1:12142 175TH RD N
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33478-4628
Practice Address - Country:US
Practice Address - Phone:561-512-6188
Practice Address - Fax:561-744-7646
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0009641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist