Basic Information
| Provider Information | |||||||||
| NPI: | 1437723004 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUDSON | ||||||||
| FirstName: | JOANN | ||||||||
| MiddleName: | PEREZ | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3537 WINDSOR CT | ||||||||
| Address2: | |||||||||
| City: | MAYS LANDING | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083303216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604090511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 113 ROUTE 73 | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080439573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568093500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2021 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 40QB00346500 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.