Provider Demographics
NPI:1700562196
Name:HUDNALL, KASEY
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:HUDNALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9914 BOSQUE CREEK CIR APT 302
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5161
Mailing Address - Country:US
Mailing Address - Phone:402-430-2222
Mailing Address - Fax:
Practice Address - Street 1:3855 UPPER CREEK DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6814
Practice Address - Country:US
Practice Address - Phone:813-635-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist