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General NPI Number Information
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NPI Number | 1184500282
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Entity Type | Individual
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Provider Name | KAITLYN LUIDHARDT
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Gender |
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 20311 PEMBERVILLE RD
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City | PEMBERVILLE
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State | OH
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Zip | 43450-9413
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Country | US
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Telephone | 419-833-8928
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Fax |
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Provider Business Mailing Address
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Address Line | 10676 SIMONDS RD
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City | BOWLING GREEN
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State | OH
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Zip | 43402-9603
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Country | US
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Telephone | 419-352-9290
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA014094
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License Number State | OH
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