Provider Demographics
NPI:1053941526
Name:LUDOVICI, AMY (ATC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LUDOVICI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RED GATE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1440
Mailing Address - Country:US
Mailing Address - Phone:607-222-0708
Mailing Address - Fax:
Practice Address - Street 1:1 CUNNINGHAM SQ
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02918-7001
Practice Address - Country:US
Practice Address - Phone:607-222-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT004712081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty