Provider Demographics
NPI:1700053170
Name:HUDSON, ANNE MCCLELLAN (PT)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MCCLELLAN
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MCCLELLAN
Other - Last Name:NICOLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 5001
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-5001
Mailing Address - Country:US
Mailing Address - Phone:704-289-4595
Mailing Address - Fax:704-220-1005
Practice Address - Street 1:701 E ROOSEVELT BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5170
Practice Address - Country:US
Practice Address - Phone:704-289-4595
Practice Address - Fax:704-220-1005
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1523225100000X
SC386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist