Provider Demographics
NPI:1578578167
Name:BUDNICK, SHELLEY LYNNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:LYNNE
Last Name:BUDNICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 E MITCHELL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-6601
Mailing Address - Country:US
Mailing Address - Phone:231-348-1011
Mailing Address - Fax:
Practice Address - Street 1:2230 E MITCHELL RD
Practice Address - Street 2:SUITE B
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-6601
Practice Address - Country:US
Practice Address - Phone:231-348-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010070932251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP16730002Medicare ID - Type Unspecified