Healthcare Provider Details

I. General information

NPI: 1780010983
Provider Name (Legal Business Name): CHRISTOPHER LUDWIG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 W MOUNTAIN RD
SHAFTSBURY VT
05262-9370
US

IV. Provider business mailing address

80 W MOUNTAIN RD
SHAFTSBURY VT
05262-9370
US

V. Phone/Fax

Practice location:
  • Phone: 802-345-3995
  • Fax:
Mailing address:
  • Phone: 802-345-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9775
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305208293
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: