Doctor Name: | MR. PETER LUDWIG |
NPI Number: | 1508245713 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT. |
License Number: | MASG-792 |
Business Practice Address: | 2030 Jennie Lee Dr Idaho Falls, ID - 834047000 |
Business Phone Number: | 2085298600 |
Business Fax Number: | 2085290036 |
Mailing Address: | 2030 Jennie Lee Dr, IDAHO FALLS |
State: | ID |
Postal Code: | 834047000 |
Phone Number: | 2085298600 |
Fax Number: | 2085290036 |
NPI Enumeration Date: | 05/20/2015 |
NPI Last Update Date: | 05/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MASG-792 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |