Provider Demographics
NPI:1053469213
Name:BUDNY, CHRISTOPHER D (LMT, NCTMB, CPFT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:D
Last Name:BUDNY
Suffix:
Gender:M
Credentials:LMT, NCTMB, CPFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1515
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-0016
Mailing Address - Country:US
Mailing Address - Phone:662-349-6822
Mailing Address - Fax:662-349-6823
Practice Address - Street 1:3121 CREECH DR.
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671
Practice Address - Country:US
Practice Address - Phone:662-349-6822
Practice Address - Fax:662-349-6823
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSLMT506225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist