MEDICARE: MRS. SUSAN MARIE HUDSON PT

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
1	225100000X	Physical Therapist	19072	MD

General Provider Information

NPI Number	:	1669292470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN MARIE HUDSON PT

Provider Business Mailing Address
First Line	:	15217 TANYARD RD
Second Line	:
City	:	SPARKS GLENCOE
State	:	MD
Zip	:	21152-9747
Country	:	US
Telephone Number	:	443-752-1874
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 POT SPRING RD
Second Line	:
City	:	TIMONIUM
State	:	MD
Zip	:	21093-2778
Country	:	US
Telephone Number	:	410-561-0200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	10/15/2024

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