# MRS. CAMILLE LIDER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1801142518
- **Gender:** F
- **Credential:** DPT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 10789141-2401 | UT | Yes |

## Other

- **Enumeration date:** 07/31/2012
- **Last updated:** 05/21/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 10789141-2401 | UTAH DOPL PT LICENSE | UT |
| 01 | — | 12756913 | CAQH | — |
| 01 | — | 1801142518 | NPI | — |
| 05 | — | 3008026 | — | UT |