MEDICARE: MRS. SHELLEY LYNNE BUDNICK PT

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	2251X0800X	Orthopedic Physical Therapist	5501007093	MI

General Provider Information

NPI Number	:	1578578167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELLEY LYNNE BUDNICK PT

Provider Business Mailing Address
First Line	:	2230 E MITCHELL RD
Second Line	:	SUITE B
City	:	PETOSKEY
State	:	MI
Zip	:	49770-6601
Country	:	US
Telephone Number	:	231-348-1011
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 E MITCHELL RD
Second Line	:	SUITE B
City	:	PETOSKEY
State	:	MI
Zip	:	49770-6601
Country	:	US
Telephone Number	:	231-348-1011
Fax Number	:

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	07/08/2007

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