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General NPI Number Information
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NPI Number | 1689947467
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Entity Type | Individual
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Provider Name | LYNNE M NIDEK MS PT
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Gender | Female
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 100 POWELL DR
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City | DUNDEE
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State | MI
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Zip | 48131-8644
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Country | US
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Telephone | 419-276-2976
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Fax |
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Provider Business Mailing Address
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Address Line | 3424 KILBURN RD
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City | BERKEY
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State | OH
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Zip | 43504-9731
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Country | US
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Telephone | 419-787-3120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501015682
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 009632
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License Number State | OH
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