Provider Demographics
NPI:1932231610
Name:HUDSON, MICHELLE LEA (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEA
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12303 ASTOR CT
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-8331
Mailing Address - Country:US
Mailing Address - Phone:816-836-0800
Mailing Address - Fax:816-836-3229
Practice Address - Street 1:638 NW JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-8278
Practice Address - Country:US
Practice Address - Phone:816-836-0800
Practice Address - Fax:816-836-3229
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005025950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist