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General NPI Number Information
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NPI Number | 1821174806
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Entity Type | Individual
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Provider Name | DEBORAH LOUISE WIDELO PT, MS, PCS
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 340 GREENING LN
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City | WINCHESTER
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State | KY
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Zip | 40391
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Country | US
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Telephone | 859-749-9305
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Fax | 859-737-3513
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Provider Business Mailing Address
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Address Line | PO BOX 4561 340 GREENING LANE
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City | WINCHESTER
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State | KY
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Zip | 40392-4561
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Country | US
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Telephone | 859-749-9305
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Fax | 859-737-3513
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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 | 003026
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 003026
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License Number State | KY
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