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Individual
MRS. CAMILLE LIDER
Active
Individual
MRS. CAMILLE LIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10789141-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10789141-2401
UTAH DOPL PT LICENSE
UT
01
—
12756913
CAQH
—
01
—
1801142518
NPI
—
05
—
3008026
—
UT
Enumeration date
07/31/2012
Last updated
05/21/2021
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