Provider Demographics
NPI:1417465600
Name:LUDWIG, KACI (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1272
Mailing Address - Country:US
Mailing Address - Phone:816-351-5498
Mailing Address - Fax:
Practice Address - Street 1:5655 S 4TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64504-1708
Practice Address - Country:US
Practice Address - Phone:816-351-5498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer