Provider Demographics
NPI:1669848693
Name:LUDWIG, NICHOLAS (ATC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 COMMONWEALTH AVE
Mailing Address - Street 2:APT 19
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5018
Mailing Address - Country:US
Mailing Address - Phone:202-258-8741
Mailing Address - Fax:
Practice Address - Street 1:1634 COMMONWEALTH AVE
Practice Address - Street 2:APT 19
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-5018
Practice Address - Country:US
Practice Address - Phone:202-258-8741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer