Provider Demographics
NPI:1326287640
Name:BUDDINGH, JACQUELINE ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ANN
Last Name:BUDDINGH
Suffix:
Gender:F
Credentials:LMT
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 5767
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33758-5767
Mailing Address - Country:US
Mailing Address - Phone:727-461-2500
Mailing Address - Fax:727-461-2500
Practice Address - Street 1:611 S PROSPECT AVE
Practice Address - Street 2:611 PROSPECT AVE S
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5627
Practice Address - Country:US
Practice Address - Phone:727-461-2500
Practice Address - Fax:727-461-2500
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA34537225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist