MEDICARE: BRETT L BUDA DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05010978A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073857678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT L BUDA DPT

Provider Business Mailing Address
First Line	:	710 N NILES AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46617-1924
Country	:	US
Telephone Number	:	574-647-1610
Fax Number	:	574-237-6069

Provider Business Practice Location Address
First Line	:	3221 BEACON PKWY STE 100
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-7196
Country	:	US
Telephone Number	:	574-647-2930
Fax Number	:	574-647-2935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	03/31/2021

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Directions to “ BRETT L BUDA DPT” Practice Location

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