Provider Demographics
NPI:1861645335
Name:BUDDENHAGEN, MICHELE DAWN (PT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:DAWN
Last Name:BUDDENHAGEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:DAWN
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:15 DORN PL
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3018
Mailing Address - Country:US
Mailing Address - Phone:631-235-2483
Mailing Address - Fax:
Practice Address - Street 1:15 DORN PL
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-3018
Practice Address - Country:US
Practice Address - Phone:631-235-2483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011747-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist