Provider Demographics
NPI:1114740222
Name:HUDSON, ANDREW HUNTER (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:HUNTER
Last Name:HUDSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 S VILLA SAN MARCO DR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4153
Mailing Address - Country:US
Mailing Address - Phone:229-406-2654
Mailing Address - Fax:
Practice Address - Street 1:190 SOUTHPARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4209
Practice Address - Country:US
Practice Address - Phone:904-824-1478
Practice Address - Fax:904-824-8071
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT42330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist