Basic Information
| Provider Information | |||||||||
| NPI: | 1205162575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUDSON | ||||||||
| FirstName: | BRANDY | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3705 W MEMORIAL RD | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731341512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057496281 | ||||||||
| FaxNumber: | 4059366496 | ||||||||
| Practice Location | |||||||||
| Address1: | 9210 S PENN AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731596902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057597719 | ||||||||
| FaxNumber: | 4057597718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2009 | ||||||||
| LastUpdateDate: | 10/21/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4276 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.