Provider Demographics
NPI:1255764320
Name:LUDWIG, MELISSA LYNN (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-3000
Mailing Address - Country:US
Mailing Address - Phone:814-381-8120
Mailing Address - Fax:
Practice Address - Street 1:212 CARLISLE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3000
Practice Address - Country:US
Practice Address - Phone:814-381-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist