Provider Demographics
NPI:1568095669
Name:LUDWIG, ELIZABETH H (LMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:H
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12205 COUNTY LINE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7720
Mailing Address - Country:US
Mailing Address - Phone:256-461-7775
Mailing Address - Fax:256-461-7756
Practice Address - Street 1:12205 COUNTY LINE RD
Practice Address - Street 2:SUITE D
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7720
Practice Address - Country:US
Practice Address - Phone:256-461-7775
Practice Address - Fax:256-461-7756
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1659225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL14616454OtherCAQH