Provider Demographics
NPI:1396773818
Name:HUDACK, MICHEAL D (PT)
Entity type:Individual
Prefix:
First Name:MICHEAL
Middle Name:D
Last Name:HUDACK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4846 LIBRARY RD
Mailing Address - Street 2:ROUTE 88
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2962
Mailing Address - Country:US
Mailing Address - Phone:412-835-2259
Mailing Address - Fax:412-835-2543
Practice Address - Street 1:4846 LIBRARY RD
Practice Address - Street 2:ROUTE 88
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2962
Practice Address - Country:US
Practice Address - Phone:412-835-2259
Practice Address - Fax:412-835-2543
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008076L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA251570641OtherTAX ID
PA0015935850010Medicaid
PA251570641OtherTAX ID