Provider Demographics
NPI:1003374505
Name:BUDDE, BRAD EDWARD (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:EDWARD
Last Name:BUDDE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34316 VIA FORTUNA
Mailing Address - Street 2:
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1310
Mailing Address - Country:US
Mailing Address - Phone:949-933-4515
Mailing Address - Fax:
Practice Address - Street 1:34316 VIA FORTUNA
Practice Address - Street 2:
Practice Address - City:CAPISTRANO BEACH
Practice Address - State:CA
Practice Address - Zip Code:92624-1310
Practice Address - Country:US
Practice Address - Phone:949-933-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20093208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation