Provider Demographics
NPI:1780240366
Name:BUDOCK, ALEXA NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:NICOLE
Last Name:BUDOCK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:NICOLE
Other - Last Name:DICERCHIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:224 STRAWBRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4602
Mailing Address - Country:US
Mailing Address - Phone:856-677-4000
Mailing Address - Fax:856-234-3014
Practice Address - Street 1:5479 POTTSVILLE PIKE STE 200
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8634
Practice Address - Country:US
Practice Address - Phone:610-926-6778
Practice Address - Fax:610-926-7200
Is Sole Proprietor?:No
Enumeration Date:2019-05-19
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist