Provider Demographics
NPI:1861973539
Name:LUEDKE, ASHLEY (ATC/L)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:LUEDKE
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 BAGBY AVE APT 512
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-0020
Mailing Address - Country:US
Mailing Address - Phone:507-269-9000
Mailing Address - Fax:
Practice Address - Street 1:4900 BAGBY AVE APT 512
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-0020
Practice Address - Country:US
Practice Address - Phone:507-269-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT60122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty