Provider Demographics
NPI:1659488062
Name:BUDLOW, HERSCHEL (PT)
Entity Type:Individual
Prefix:
First Name:HERSCHEL
Middle Name:
Last Name:BUDLOW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12111 TULLAMORE CT UNIT 103
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-8154
Mailing Address - Country:US
Mailing Address - Phone:410-925-6873
Mailing Address - Fax:
Practice Address - Street 1:12111 TULLAMORE CT UNIT 103
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-8154
Practice Address - Country:US
Practice Address - Phone:410-925-6873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ102Medicare ID - Type Unspecified