Michael Damon Hudson, P.T.A.

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA967 Issued in AR

Practice address

1101 Jackson St SW
Gravette, AR 72736-9121

Phone

(479) 344-6740

NPI assigned

Mar 16, 2007

Last updated

Jan 19, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295395200000",
    "number": "1922132166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10542 BLUE JAY RD",
            "city": "PEA RIDGE",
            "state": "AR",
            "postal_code": "727512724",
            "telephone_number": "870-834-5332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 JACKSON ST SW",
            "city": "GRAVETTE",
            "state": "AR",
            "postal_code": "727369121",
            "telephone_number": "479-344-6740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "MICHAEL",
        "middle_name": "DAMON",
        "credential": "P.T.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2011-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AR",
            "license": "PTA967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS PHYSICAL THERAPY BOARD",
            "identifier": "PTA 967",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Gravette, AR
• Providers in Gravette, AR by specialty
• Physical Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.