Healthcare Provider Details

I. General information

NPI: 1710894480
Provider Name (Legal Business Name): MARCUS HUDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HARTFORD ST
HOULTON ME
04730-1891
US

IV. Provider business mailing address

1508 10TH ST
AUBURN NE
68305-1415
US

V. Phone/Fax

Practice location:
  • Phone: 207-532-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPA7544
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: