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Organization
THE WELLNESS COLLABORATIVE
Active
Organization
THE WELLNESS COLLABORATIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA MARIE VIDAKOVIC PHYSICAL THERAPIST (PHYSICAL THERAPIST)
(814) 315-2548
Entity
Organization
Contact information
Practice address
1343 W 38TH ST, ERIE, PA 16508-2461
(814) 315-2548
Mailing address
4312 ALISON AVE, ERIE, PA 16506-6164
(814) 323-0045
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
01/16/2019
Last updated
01/16/2019
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