Stacy Kristine Budde, DPT
Individual provider Active NPI Physical Therapist · Berlin, WI
NPI 1073867149 · NPPES record last updated Oct 29, 2012
Key facts
- NPI
- 1073867149
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 10104-024 (WI)
- Practice address
- 225 Memorial Dr
Berlin, WI 54923-1243 - Phone
- (920) 361-5534
- NPI assigned
- Oct 29, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7052 | CO | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| 10104-024 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thedacare Medical Center - Berlin, Inc. | Past | Accepting new patients |
Interoperability endpoints
- sbudde120855@direct.thedacare.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 10104-024 | WI | Yes |
Addresses
Primary practice location
225 Memorial Dr
Berlin, WI 54923-1243
Mailing address
225 Memorial Dr
Berlin, WI 54923-1243
Phone (920) 361-5534
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10104-024 | Other | WI | STATE OF WI |
Other providers in Berlin, WI
- Jessica M Braun
- Robert David Brooks
- Brown Wilcox Trustees, Inc.
- M Jean Bruce
- David Budde
- Carrie Calbaum
- Jeffrey Carroll
- Central Wisconsin Anesthesi
- Central Wisconsin Orthopedics and Sports Medicine
- Craig S Chertack
All providers in Berlin, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.