Provider Demographics
NPI:1225249246
Name:RICARD, LUDE REGINE (PT)
Entity Type:Individual
Prefix:MISS
First Name:LUDE
Middle Name:REGINE
Last Name:RICARD
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 1:5703 OBERLIN DR
Mailing Address - Street 2:STE 308
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1743
Mailing Address - Country:US
Mailing Address - Phone:858-412-4787
Mailing Address - Fax:
Practice Address - Street 1:5703 OBERLIN DR
Practice Address - Street 2:STE 308
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1743
Practice Address - Country:US
Practice Address - Phone:619-621-9215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23348225100000X
CAPT 33814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 33814OtherCALIFORNIA PHYSICAL THERAPY BOARD
CACS766ZMedicare PIN