Provider Demographics
NPI:1134549900
Name:LUDWIG, TARA (LAT, ATC)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:MOHNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19540-1109
Mailing Address - Country:US
Mailing Address - Phone:610-823-5380
Mailing Address - Fax:
Practice Address - Street 1:101 S WAVERLY ST
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-2644
Practice Address - Country:US
Practice Address - Phone:610-823-5380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARTO0001462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer