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NPI Code Detail

MEDICARE: MRS. ASHLEY LYN VIDT PTA

MEDICARE: MRS. ASHLEY LYN VIDT PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantTE008087PA

General Provider Information

NPI Number : 1316199060
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ASHLEY LYN VIDT PTA
Provider Business Mailing Address
First Line : 127 3RD ST
Second Line :
City : MC DONALD
State : PA
Zip : 15057-1141
Country : US
Telephone Number : 412-608-4586
Fax Number :
Provider Business Practice Location Address
First Line : 90 HUMBERT LN
Second Line :
City : WASHINGTON
State : PA
Zip : 15301-6549
Country : US
Telephone Number : 724-228-4740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2008
Last Update Date : 01/21/2016

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