Individual provider Active NPI

Jordan Hudson, DPT

  • Physical Therapist
  • North Augusta, SC
National Provider Identifier
1104618917
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
CP050875T Issued in SC
Practice address
440 W Martintown Rd Ste 101
North Augusta, SC 29841-6104
Phone
(803) 441-0025
NPI assigned
May 19, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X CP050875T SC Primary

Addresses

Primary practice location

440 W Martintown Rd Ste 101
North Augusta, SC 29841-6104

Mailing address

2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20251022002057 VA Practitioner - Physical Therapist in Private Practice 6507354545 Reassigns benefits to 1 organization
I20260423001379 SC Practitioner - Physical Therapist in Private Practice 6507354545 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tidewater Physical Therapy LLCGroup PAC ID 6406759281, 225 clinicians
Georgialina Physical Therapy Associates LLCGroup PAC ID 6002812401, 406 clinicians

Practice addresses (Care Compare)

300 B Temple Lake Dr
Suite 1
Colonial Heights, VA 23834-2973
Phone (804) 524-9036

440 W Martintown Rd
Suite 101
North Augusta, SC 29841-6104
Phone (803) 441-0025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CP050875TSCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Physical Therapy, LLC Physical Therapist CurrentSince Aug 7, 2025 Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist CurrentSince Aug 7, 2025 Accepting new patients
Georgialina Physical Therapy Associates LLC Physical Therapist CurrentSince Feb 28, 2026 Accepting new patients

Locations

2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250

440 W Martintown Rd
Ste 101
North Augusta, SC 29841
Phone (803) 441-0025

300B Temple Lake Dr
Ste 1
Colonial Heights, VA 23834
Phone (804) 452-4903

10128 W Broad St
Bldg Iii
Glen Allen, VA 23060
Phone (804) 217-9210

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1104618917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "630-575-6200",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 W MARTINTOWN RD STE 101",
            "city": "NORTH AUGUSTA",
            "state": "SC",
            "postal_code": "298416104",
            "telephone_number": "803-441-0025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "JORDAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-19",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "CP050875T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Augusta, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.