Provider Demographics
NPI:1922010412
Name:LUEDTKE, ROBERT RAY (ATC,LAT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:RAY
Last Name:LUEDTKE
Suffix:
Gender:M
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 VALLEY FRG
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2348
Mailing Address - Country:US
Mailing Address - Phone:972-680-9560
Mailing Address - Fax:
Practice Address - Street 1:1101 OHIO DR
Practice Address - Street 2:SUITE 110
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5330
Practice Address - Country:US
Practice Address - Phone:972-985-2622
Practice Address - Fax:972-985-2630
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXATO6162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer