Provider Demographics
NPI:1093762551
Name:LUEDKE, BEVERLY WOLF (PT)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:WOLF
Last Name:LUEDKE
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:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:ROSEBUD
Mailing Address - State:TX
Mailing Address - Zip Code:76570-0637
Mailing Address - Country:US
Mailing Address - Phone:254-583-4690
Mailing Address - Fax:254-583-2038
Practice Address - Street 1:701 MURRAY AVE
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2763
Practice Address - Country:US
Practice Address - Phone:512-446-9990
Practice Address - Fax:512-446-9991
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1019172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1019172OtherSTATE PROFESSIONAL LICENS
TX1019172OtherSTATE PROFESSIONAL LICENS