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General NPI Number Information
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NPI Number | 1114740222
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Entity Type | Individual
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Provider Name | ANDREW HUNTER HUDSON PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 190 SOUTHPARK BLVD STE 100
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4209
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Country | US
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Telephone | 904-824-1478
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Fax | 904-824-8071
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Provider Business Mailing Address
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Address Line | 440 S VILLA SAN MARCO DR UNIT 103
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4153
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Country | US
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Telephone | 229-406-2654
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT42330
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License Number State | FL
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