Healthcare Provider Details

I. General information

NPI: 1033474150
Provider Name (Legal Business Name): KERAN R LUDWICK MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SPRINGHALL DR STE A
GOOSE CREEK SC
29445-5335
US

IV. Provider business mailing address

PO BOX 118008
NORTH CHARLESTON SC
29423-8008
US

V. Phone/Fax

Practice location:
  • Phone: 843-302-8845
  • Fax: 843-553-4436
Mailing address:
  • Phone: 843-266-2520
  • Fax: 843-553-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8032
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: