Healthcare Provider Details

I. General information

NPI: 1265973473
Provider Name (Legal Business Name): PAULA M LUDEWIG PT, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOYNTON HEALTH SERVICE 410 CHURCH STREET SE
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

BOYNTON HEALTH SERVICE 410 CHURCH STREET SE
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-8400
  • Fax: 612-625-1434
Mailing address:
  • Phone: 612-625-8400
  • Fax: 612-625-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4181
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: