Provider Demographics
NPI:1548702343
Name:HUDSON, FARRAH LEE CHONG (MPT)
Entity type:Individual
Prefix:MRS
First Name:FARRAH
Middle Name:LEE CHONG
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:FARRAH
Other - Middle Name:LEE
Other - Last Name:CHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:3000 N TRIUMPH BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4999
Mailing Address - Country:US
Mailing Address - Phone:801-766-2088
Mailing Address - Fax:
Practice Address - Street 1:3000 N TRIUMPH BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4999
Practice Address - Country:US
Practice Address - Phone:801-766-2088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT379655-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist