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NPI Code Detail

MEDICARE: MR. JEREMIAH HUDSON LPTA

MEDICARE: MR. JEREMIAH HUDSON LPTA
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
1225200000XPhysical Therapy Assistant5935OH

General Provider Information

NPI Number : 1174642714
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEREMIAH HUDSON LPTA
Provider Business Mailing Address
First Line : 7203 WESTLAKE AVE
Second Line :
City : PARMA
State : OH
Zip : 44129-2388
Country : US
Telephone Number : 440-503-2727
Fax Number :
Provider Business Practice Location Address
First Line : 6455 PEARL RD
Second Line :
City : PARMA HEIGHTS
State : OH
Zip : 44130-2984
Country : US
Telephone Number : 440-887-6254
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 07/08/2007

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