Provider Demographics
NPI:1801106109
Name:BUDD, SUSAN J (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:BUDD
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 1:913 BOLGER CT
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2030
Mailing Address - Country:US
Mailing Address - Phone:636-305-9599
Mailing Address - Fax:636-305-9799
Practice Address - Street 1:913 BOLGER CT
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2030
Practice Address - Country:US
Practice Address - Phone:636-305-9599
Practice Address - Fax:636-305-9799
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO01241OtherPHYSICAL THERAPIST