Provider Demographics
NPI:1194290114
Name:LUDTKE, LAUREN (DPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LUDTKE
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 1:3929 PEACHTREE RD NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3374
Mailing Address - Country:US
Mailing Address - Phone:770-740-1860
Mailing Address - Fax:470-299-5025
Practice Address - Street 1:3929 PEACHTREE RD NE STE 100
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3374
Practice Address - Country:US
Practice Address - Phone:770-740-1860
Practice Address - Fax:470-299-5025
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014964225100000X
MD28147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist