Active NPI
Mary Shannon Ludloff, P.T.
- Physical Therapist
- Long Beach, CA
National Provider Identifier
1376667600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 19911
- Practice address
- 4103 N Viking Way
Ste C
Long Beach, CA 90808-1490 - Phone
- (615) 778-4066
- NPI assigned
- Mar 19, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 19911 | CA | Primary |
Addresses
Primary practice location
4103 N Viking Way
Ste C
Long Beach, CA 90808-1490
Mailing address
4103 N Viking Way
Ste C
Long Beach, CA 90808-1490
Phone (615) 778-4066
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481760000000",
"number": "1376667600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4103 N VIKING WAY",
"address_2": "STE C",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908081490",
"telephone_number": "615-778-4066",
"fax_number": "615-778-9114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4103 N VIKING WAY",
"address_2": "STE C",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908081490",
"telephone_number": "615-778-4066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUDLOFF",
"first_name": "MARY",
"middle_name": "SHANNON",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-19",
"last_updated": "2016-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "19911",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.