Provider Demographics
NPI:1255771523
Name:LUDY, TAYLOR (ATC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:LUDY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 BROOKWOOD POINT PL
Mailing Address - Street 2:#135
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:135 COMMONWEALTH DR
Practice Address - Street 2:SUITE 250
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4831
Practice Address - Country:US
Practice Address - Phone:864-417-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer