Healthcare Provider Details

I. General information

NPI: 1912407776
Provider Name (Legal Business Name): LAWRENCE MICHAEL HUDSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9809 39TH AVE STE 2
PLEASANT PRAIRIE WI
53158-3733
US

IV. Provider business mailing address

197 STATE ST
BOYNE CITY MI
49712-1288
US

V. Phone/Fax

Practice location:
  • Phone: 262-925-5080
  • Fax:
Mailing address:
  • Phone: 231-582-6365
  • Fax: 231-582-3738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010980
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17659-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: