Provider Demographics
NPI:1811431174
Name:HUDSON, ANGELINA (LMT, MMP)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 W MCDERMOTT DR
Mailing Address - Street 2:#222 RM 17
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3022
Mailing Address - Country:US
Mailing Address - Phone:469-573-2341
Mailing Address - Fax:
Practice Address - Street 1:1328 W MCDERMOTT DR
Practice Address - Street 2:#222 RM 17
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3022
Practice Address - Country:US
Practice Address - Phone:469-573-2341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT125497225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist