Provider Demographics
NPI:1962793083
Name:HUDRAN, SAMANTHA J (LMT)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:J
Last Name:HUDRAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-0098
Mailing Address - Country:US
Mailing Address - Phone:302-382-5851
Mailing Address - Fax:
Practice Address - Street 1:231 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952-1238
Practice Address - Country:US
Practice Address - Phone:302-382-5851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-23
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0003049225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist