Provider Demographics
NPI:1770093585
Name:HUDSON, TIMOTHY DELMAR (DPT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DELMAR
Last Name:HUDSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 GALBAR ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3444
Mailing Address - Country:US
Mailing Address - Phone:760-840-9028
Mailing Address - Fax:
Practice Address - Street 1:900 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3919
Practice Address - Country:US
Practice Address - Phone:760-753-6423
Practice Address - Fax:760-753-4979
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38201225100000X
NV2703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist