Provider Demographics
NPI:1528168218
Name:PENINSULA SPINE EDUCATION &TREATMENT CENTER
Entity type:Organization
Organization Name:PENINSULA SPINE EDUCATION &TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LUDWIG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:650-348-5112
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty