=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598578874
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUCILLE N BIDDINGER PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2025
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14442 US HIGHWAY 33 # 14357
-----------------------------------------------------
City | LAKEVIEW
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43331-9284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-843-4929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1645 LEE ANN DR
-----------------------------------------------------
City | LIMA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45801-1506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-308-3454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 003763
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------