Provider Demographics
NPI:1275900391
Name:LUDTKE, BRIANNA C (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:C
Last Name:LUDTKE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8290 UNIVERSITY AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-1876
Mailing Address - Country:US
Mailing Address - Phone:763-786-9543
Mailing Address - Fax:763-786-3320
Practice Address - Street 1:8290 UNIVERSITY AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:763-786-9543
Practice Address - Fax:763-786-3320
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist