Provider Demographics
NPI:1487016408
Name:LUDWIG, TRACY ANNETTE (CMT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANNETTE
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 JOYCE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-0429
Mailing Address - Country:US
Mailing Address - Phone:320-761-6331
Mailing Address - Fax:
Practice Address - Street 1:225 N BENTON DR STE 104
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1569
Practice Address - Country:US
Practice Address - Phone:320-761-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist