Healthcare Provider Details

I. General information

NPI: 1205162575
Provider Name (Legal Business Name): BRANDY NICOLE HUDSON MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9210 S PENN AVE
OKLAHOMA CITY OK
73159-6902
US

IV. Provider business mailing address

3705 W MEMORIAL RD SUITE 310
OKLAHOMA CITY OK
73134-1512
US

V. Phone/Fax

Practice location:
  • Phone: 405-759-7719
  • Fax: 405-759-7718
Mailing address:
  • Phone: 405-749-6281
  • Fax: 405-936-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4276
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: