Healthcare Provider Details

I. General information

NPI: 1225353196
Provider Name (Legal Business Name): BARBARA LUEDTKE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 ALMANOR AVE
SUNNYVALE CA
94085-2934
US

IV. Provider business mailing address

PO BOX 390667
MOUNTAIN VIEW CA
94039-0667
US

V. Phone/Fax

Practice location:
  • Phone: 408-734-2800
  • Fax: 408-734-8522
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT26076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: