Individual
VICTOR ERUDE LIDAYWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1701 W JACKSON ST, STE C, MACOMB, IL 61455-3175
(309) 331-3590
Mailing address
305 E SUMMIT ST, MACOMB, IL 61455-3223
(309) 837-1748
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070.017800
IL
261QP2000X
Physical Therapy Clinic/Center
Primary
070.017800
IL
Other
Enumeration date
01/23/2019
Last updated
02/02/2019
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