Individual
DR. LACE ELLY LUEDKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT PHD DPT OCS CSCS
Contact information
Practice address
1901 E CAPITOL DR, APPLETON, WI 54911-8488
(920) 931-2532
Mailing address
800 ALGOMA BLVD, UW-OSHKOSH, 108B ALBEE HALL, OSHKOSH, WI 54901
(920) 424-0891
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2611
AR
225100000X
Physical Therapist
Primary
5847024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1305
MCKENZIE INSTITUTE CERT
—
01
—
977732
NSCA CSCS
—
Enumeration date
05/03/2006
Last updated
07/21/2022
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