Basic Information
| Provider Information | |||||||||
| NPI: | 1407212897 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VIDMAR | ||||||||
| FirstName: | LINDSEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1436 S LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | SHAWANO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541663427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155266111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1436 S LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | SHAWANO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541663427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155266111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2016 | ||||||||
| LastUpdateDate: | 01/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2332-19 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.