Basic Information
| Provider Information | |||||||||
| NPI: | 1023347523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUDKE | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WOODS | ||||||||
| OtherFirstName: | REBECCA | ||||||||
| OtherMiddleName: | T | ||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1728 SUNRISE HWY | ||||||||
| Address2: | |||||||||
| City: | MERRICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115663745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169924700 | ||||||||
| FaxNumber: | 5169924722 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 HEMPSTEAD AVE | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115704033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165363800 | ||||||||
| FaxNumber: | 5169924722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2009 | ||||||||
| LastUpdateDate: | 12/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 016477 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.