Basic Information
Provider Information | |||||||||
NPI: | 1780761445 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MORRIS | ||||||||
FirstName: | LYDIA | ||||||||
MiddleName: | HUDGINS | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 247 | ||||||||
Address2: |   | ||||||||
City: | MIDLOTHIAN | ||||||||
State: | VA | ||||||||
PostalCode: | 23113 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8043785010 | ||||||||
FaxNumber: | 8043783264 | ||||||||
Practice Location | |||||||||
Address1: | 2000 BREMO ROAD | ||||||||
Address2: | SUITE 202 | ||||||||
City: | RICHMOND | ||||||||
State: | VA | ||||||||
PostalCode: | 23226 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8042850148 | ||||||||
FaxNumber: | 8046736026 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/01/2006 | ||||||||
LastUpdateDate: | 08/29/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305001623 | VA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 082890 | 01 | VA | ANTHEM | OTHER |