Provider Demographics
NPI:1902906696
Name:LUDWIG, CAROL ANN (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:LUDWIG
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 1:424 N SAN MATEO DR
Mailing Address - Street 2:100
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2491
Mailing Address - Country:US
Mailing Address - Phone:650-348-5112
Mailing Address - Fax:650-348-6031
Practice Address - Street 1:424 N SAN MATEO DR
Practice Address - Street 2:100
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2491
Practice Address - Country:US
Practice Address - Phone:650-348-5112
Practice Address - Fax:650-348-6031
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251X0800X2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100710Medicare ID - Type UnspecifiedPHYSICAL THERAPIST