Provider Demographics
NPI:1770648438
Name:HUDSON, TOM (LMP)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:
Last Name:HUDSON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 NE HIGHWAY 99 STE G
Mailing Address - Street 2:PMB 364
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8748
Mailing Address - Country:US
Mailing Address - Phone:360-993-1320
Mailing Address - Fax:360-993-5321
Practice Address - Street 1:6108 NE HIGHWAY 99 STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8751
Practice Address - Country:US
Practice Address - Phone:360-993-1320
Practice Address - Fax:360-993-5321
Is Sole Proprietor?:No
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0014678225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist