Provider Demographics
NPI:1679623581
Name:BUDDEN, ELIZABETH J (DPT, MOT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:BUDDEN
Suffix:
Gender:F
Credentials:DPT, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 WYE OAK LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-4374
Mailing Address - Country:US
Mailing Address - Phone:941-592-8886
Mailing Address - Fax:
Practice Address - Street 1:2553 WYE OAK LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-4374
Practice Address - Country:US
Practice Address - Phone:941-592-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23262225100000X
FLOT12128225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891872400Medicaid
FLOT12128OtherSTATE LICENSE NUMBER
FLPT23262OtherSTATE PT LICENSE NUMBER
FLPT23262OtherSTATE PT LICENSE NUMBER
FLAB559WMedicare PIN