Provider Demographics
NPI:1427522283
Name:LUDZACK, HANNAH (ATS)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:LUDZACK
Suffix:
Gender:F
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 KENMOOR AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:616-483-3480
Mailing Address - Fax:
Practice Address - Street 1:2457 GUM BRANCH RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4008
Practice Address - Country:US
Practice Address - Phone:910-938-7555
Practice Address - Fax:910-938-7544
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCP031201T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty