Provider Demographics
NPI:1790813806
Name:LUDWIG, GENEVIEVE ELIZABETH (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:GENEVIEVE
Middle Name:ELIZABETH
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3203 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-4008
Mailing Address - Country:US
Mailing Address - Phone:702-317-3178
Mailing Address - Fax:541-962-3577
Practice Address - Street 1:1 UNIVERSITY BLVD
Practice Address - Street 2:ATHLETIC TRAINING QUINN COLISEUM
Practice Address - City:LAGRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-4008
Practice Address - Country:US
Practice Address - Phone:541-962-3750
Practice Address - Fax:541-962-3577
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-10074722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer