Individual
JOHANNA L. VIDOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4647 MEDICAL DR, SAN ANTONIO, TX 78229-4403
(210) 358-2710
(210) 358-4738
Mailing address
PO BOX 87, SAN ANTONIO, TX 78291-0087
(210) 358-9172
(210) 358-9183
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
110580
TX
Other
Enumeration date
03/30/2013
Last updated
05/27/2015
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