Healthcare Provider Details

I. General information

NPI: 1902621972
Provider Name (Legal Business Name): MIGUEL VIDAL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PARK DR
WESTFORD MA
01886-3511
US

IV. Provider business mailing address

4010 15TH ST SW
LEHIGH ACRES FL
33976-3201
US

V. Phone/Fax

Practice location:
  • Phone: 978-329-1144
  • Fax:
Mailing address:
  • Phone: 239-470-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL89314
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: