Active NPI
Tyler Luedtke, DPT
- Physical Therapist
- Two Rivers, WI
National Provider Identifier
1689156481
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 14392
- Practice address
- 5300 Memorial Dr
Two Rivers, WI 54241 - Phone
- (920) 793-7570
- NPI assigned
- Aug 29, 2018
- Last updated
- Aug 30, 2018
- Sex
- Male
- 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 | 14392 | WI | Primary |
Addresses
Primary practice location
5300 Memorial Dr
Two Rivers, WI 54241
Mailing address
2423 Johnston Dr Unit 5
Manitowoc, WI 54220-9632
Phone (920) 960-7587
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14392 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535587200000",
"number": "1689156481",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2423 JOHNSTON DR UNIT 5",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542209632",
"telephone_number": "920-960-7587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5300 MEMORIAL DR",
"city": "TWO RIVERS",
"state": "WI",
"postal_code": "54241",
"telephone_number": "920-793-7570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUEDTKE",
"first_name": "TYLER",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-29",
"last_updated": "2018-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "14392",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Two Rivers, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.