Provider Demographics
NPI:1144369687
Name:HUDAK, DAVID ALLEN JR (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:HUDAK
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MACARTHUR BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2920
Mailing Address - Country:US
Mailing Address - Phone:219-836-1060
Mailing Address - Fax:219-836-1014
Practice Address - Street 1:801 MACARTHUR BLVD STE 304
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2920
Practice Address - Country:US
Practice Address - Phone:219-836-1060
Practice Address - Fax:219-836-1014
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006797A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist