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General NPI Number Information
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NPI Number | 1922010412
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Entity Type | Individual
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Provider Name | ROBERT RAY LUEDTKE ATC,LAT
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1101 OHIO DR SUITE 110
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City | PLANO
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State | TX
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Zip | 75093-5330
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Country | US
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Telephone | 972-985-2622
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Fax | 972-985-2630
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Provider Business Mailing Address
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Address Line | 2404 VALLEY FRG
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City | RICHARDSON
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State | TX
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Zip | 75080-2348
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Country | US
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Telephone | 972-680-9560
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATO616
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License Number State | TX
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