Provider Demographics
NPI:1730162462
Name:DEWOLF, LUDO (PT)
Entity type:Individual
Prefix:MR
First Name:LUDO
Middle Name:
Last Name:DEWOLF
Suffix:
Gender:M
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:PO BOX 357279
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7279
Mailing Address - Country:US
Mailing Address - Phone:352-332-3481
Mailing Address - Fax:352-332-3213
Practice Address - Street 1:4343 W NEWBERRY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2817
Practice Address - Country:US
Practice Address - Phone:352-373-6565
Practice Address - Fax:352-373-6112
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y5478ZMedicare ID - Type Unspecified