Provider Demographics
NPI:1770774820
Name:BUDZINSKI, KAREN (PTA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BUDZINSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W EDGEWOOD CT
Mailing Address - Street 2:B
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2402
Mailing Address - Country:US
Mailing Address - Phone:309-263-4200
Mailing Address - Fax:309-263-4209
Practice Address - Street 1:430 W EDGEWOOD CT
Practice Address - Street 2:B
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2402
Practice Address - Country:US
Practice Address - Phone:309-263-4200
Practice Address - Fax:309-263-4209
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant