Individual provider Active NPI

Stephanie Marie Budrock, DPT, PT

  • Physical Therapist
  • Herndon, VA
National Provider Identifier
1699669507
Registry record updated Jun 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
CP044990T Issued in VA
Practice address
13039 Worldgate Dr
Herndon, VA 20170-4374
Phone
(703) 689-3164
Fax
(703) 689-3167
NPI assigned
Jun 5, 2025
Last updated
Jun 5, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 40QA02340400 NJ
Physical Therapist 225100000X CP044990T VA Primary

Addresses

Primary practice location

13039 Worldgate Dr
Herndon, VA 20170-4374

Mailing address

PO Box 1769
Middleburg, VA 20118-1769
Phone (703) 689-3164

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250611003737 DC Practitioner - Physical Therapist in Private Practice 9931619509 Reassigns benefits to 1 organization
I20250821001813 VA Practitioner - Physical Therapist in Private Practice 9931619509 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jackson Clinics Limited PartnershipGroup PAC ID 2860623295, 116 clinicians

Practice addresses (Care Compare)

13039 Worldgate Dr
Herndon, VA 20170-4374
Phone (703) 689-3164

43490 Yukon Dr
Ashburn, VA 20147-6990
Phone (703) 729-7920

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA02340400NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Clinics Limited Partnership Physical Therapist CurrentSince Jul 21, 2025 Accepting new patients
The Jackson Clinics LLC Physical Therapist Past Accepting new patients

Locations

43490 Yukon Dr
Ste 212
Ashburn, VA 20147
Phone (703) 729-7920

43490 Yukon Dr
Ashburn, VA 20147
Phone (703) 729-7920

12701 Fair Lakes Cir
Ste 102
Fairfax, VA 22033

13039 Worldgate Dr
Herndon, VA 20170
Phone (703) 689-3164

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1749081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749081600000",
    "number": "1699669507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1769",
            "city": "MIDDLEBURG",
            "state": "VA",
            "postal_code": "201181769",
            "telephone_number": "703-689-3164",
            "fax_number": "703-689-3167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13039 WORLDGATE DR",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704374",
            "telephone_number": "703-689-3164",
            "fax_number": "703-689-3167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUDROCK",
        "first_name": "STEPHANIE",
        "middle_name": "MARIE",
        "credential": "DPT, PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-05",
        "last_updated": "2025-06-05",
        "certification_date": "2025-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA02340400",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "CP044990T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Herndon, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.