Provider Demographics
NPI:1972652485
Name:HUDSON, SUZANNE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MARIE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 WESTBOURNE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248
Mailing Address - Country:US
Mailing Address - Phone:513-619-8700
Mailing Address - Fax:513-922-3700
Practice Address - Street 1:3260 WESTBOURNE DRIVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248
Practice Address - Country:US
Practice Address - Phone:513-619-8700
Practice Address - Fax:513-922-3700
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT5032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHU4179201Medicare ID - Type Unspecified