Provider Demographics
NPI:1720216450
Name:LUDLOW, ALLEN JEREMY (DPT)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:JEREMY
Last Name:LUDLOW
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5547 S 4015 W
Mailing Address - Street 2:# 7
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84118-4437
Mailing Address - Country:US
Mailing Address - Phone:801-967-6055
Mailing Address - Fax:801-967-6934
Practice Address - Street 1:5547 S 4015 W
Practice Address - Street 2:# 7
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118-4437
Practice Address - Country:US
Practice Address - Phone:801-967-6055
Practice Address - Fax:801-967-6934
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7343209-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist