Provider Demographics
NPI:1275725533
Name:BUDRES, SHAYNA MICHELE (DPT)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:MICHELE
Last Name:BUDRES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:
Other - Last Name:GARFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 30516
Mailing Address - Street 2:DEPT 5300
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909
Mailing Address - Country:US
Mailing Address - Phone:616-754-7040
Mailing Address - Fax:616-754-7888
Practice Address - Street 1:2425 W WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838
Practice Address - Country:US
Practice Address - Phone:616-225-2325
Practice Address - Fax:616-754-7888
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5510102696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30435OtherBLUE CROSS BLUE SHIELD
MI2679020Medicaid
MI30435OtherBLUE CROSS BLUE SHIELD