Provider Demographics
NPI:1336175694
Name:BUDD, COURTNEY A (MSPT)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:A
Last Name:BUDD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:221 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2278
Practice Address - Country:US
Practice Address - Phone:856-536-1706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018335225100000X
NJ40QAO0758000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2220159OtherUNITED HEALTHCARE
NJ2253372000OtherAMERIHEALTH/KEYSTONE/IBC
NJ1342066OtherAETNA
NJ2220159OtherUNITED HEALTHCARE