Provider Demographics
NPI:1033474150
Name:LUDWICK, KERAN R (MT)
Entity Type:Individual
Prefix:
First Name:KERAN
Middle Name:R
Last Name:LUDWICK
Suffix:
Gender:F
Credentials:MT
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 118008
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29423-8008
Mailing Address - Country:US
Mailing Address - Phone:843-266-2520
Mailing Address - Fax:843-553-4436
Practice Address - Street 1:110 SPRINGHALL DR
Practice Address - Street 2:STE A
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5335
Practice Address - Country:US
Practice Address - Phone:843-302-8845
Practice Address - Fax:843-553-4436
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8032225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist