Provider Demographics
NPI:1649360355
Name:LUDWIG, GRETA MATSON (PT)
Entity type:Individual
Prefix:
First Name:GRETA
Middle Name:MATSON
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 WILDFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-3072
Mailing Address - Country:US
Mailing Address - Phone:281-331-9420
Mailing Address - Fax:
Practice Address - Street 1:2637 LAZY BEND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-1006
Practice Address - Country:US
Practice Address - Phone:281-485-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1143337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86786TOtherBLUE CROSS/BLUE SHIELD
TX2929500OtherAETNA
TX2929500OtherAETNA