Provider Demographics
NPI:1588341226
Name:LUDWIG, JOHN BYRNE (LMT, CMT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BYRNE
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 DEVON RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1542
Mailing Address - Country:US
Mailing Address - Phone:703-939-7976
Mailing Address - Fax:
Practice Address - Street 1:165 DEVON RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1542
Practice Address - Country:US
Practice Address - Phone:703-939-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16653225700000X
VA0019010859225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist