Provider Demographics
NPI:1881093748
Name:JEREMY E HUDSON
Entity type:Organization
Organization Name:JEREMY E HUDSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:617-429-3577
Mailing Address - Street 1:137 NEWBURY ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2912
Mailing Address - Country:US
Mailing Address - Phone:617-429-3577
Mailing Address - Fax:617-334-7629
Practice Address - Street 1:137 NEWBURY ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2912
Practice Address - Country:US
Practice Address - Phone:617-429-3577
Practice Address - Fax:617-334-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-17
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000967001Medicare PIN