MEDICARE: LISA HUDSON PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT005531	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0019367220005	OTHER	PA	MA

General Provider Information

NPI Number	:	1538384276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA HUDSON PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	1828 BEVERLY RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1202
Country	:	US
Telephone Number	:	267-342-1426
Fax Number	:

Provider Business Practice Location Address
First Line	:	1828 BEVERLY RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1202
Country	:	US
Telephone Number	:	267-342-1426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/01/2019

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