Provider Demographics
NPI:1558064147
Name:BUDILO, DESTINEE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DESTINEE
Middle Name:
Last Name:BUDILO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:DESTINEE
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:12708 RIATA VISTA CIR STE A106
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-7174
Mailing Address - Country:US
Mailing Address - Phone:512-795-2422
Mailing Address - Fax:512-852-4485
Practice Address - Street 1:12708 RIATA VISTA CIR STE A106
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-7174
Practice Address - Country:US
Practice Address - Phone:512-795-2422
Practice Address - Fax:512-852-4485
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2149601225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant