Active NPI
Tanya Mercedes Budiarto, DPT
- Physical Therapist
- Walnut Creek, CA
National Provider Identifier
1124582333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT296162
- Practice address
- 1840 San Miguel Dr
Walnut Creek, CA 94596-8602 - Phone
- (925) 378-7652
- NPI assigned
- Jan 22, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT296162 | CA | Primary |
Addresses
Primary practice location
1840 San Miguel Dr
Walnut Creek, CA 94596-8602
Mailing address
1840 San Miguel Dr
Walnut Creek, CA 94596-8602
Phone (925) 378-7652
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT296162 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548115200000",
"number": "1124582333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1840 SAN MIGUEL DR",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945968602",
"telephone_number": "925-378-7652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1840 SAN MIGUEL DR",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945968602",
"telephone_number": "925-378-7652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUDIARTO",
"first_name": "TANYA",
"middle_name": "MERCEDES",
"name_prefix": "Ms.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-22",
"last_updated": "2019-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT296162",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walnut Creek, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.