Healthcare Provider Details

I. General information

NPI: 1669306379
Provider Name (Legal Business Name): MOLLY GRACE LUDWIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 STRAITS TPKE
MIDDLEBURY CT
06762-1836
US

IV. Provider business mailing address

45 GRAND ST
CANTON MA
02021-1809
US

V. Phone/Fax

Practice location:
  • Phone: 203-598-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: