Provider Demographics
NPI:1063694636
Name:LUDWIG, LYNSAY JO (DPT)
Entity type:Individual
Prefix:
First Name:LYNSAY
Middle Name:JO
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2627
Mailing Address - Country:US
Mailing Address - Phone:541-881-7330
Mailing Address - Fax:541-881-7334
Practice Address - Street 1:898 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2627
Practice Address - Country:US
Practice Address - Phone:541-881-7330
Practice Address - Fax:541-881-7334
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5472225100000X
ID2234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist