Provider Demographics
NPI:1962547349
Name:BUDLONG, JEAN VANO (PT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:VANO
Last Name:BUDLONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 HUNTERS RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-6658
Mailing Address - Country:US
Mailing Address - Phone:863-858-9346
Mailing Address - Fax:
Practice Address - Street 1:3133 LAKELAND HILLS BLVD STE 1-2
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2208
Practice Address - Country:US
Practice Address - Phone:863-603-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 0010900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist