Individual
LISA WIDDOWSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, CTT
Contact information
Practice address
7200 S 84TH ST STE 140, LA VISTA, NE 68128-2115
(402) 915-1590
(402) 939-0614
Mailing address
7210 S 75TH ST, LA VISTA, NE 68128-2220
(402) 590-9384
(402) 939-0614
Taxonomy
Speciality
Code
Description
License number
State
173C00000X
Reflexologist
—
—
174H00000X
Health Educator
—
—
225700000X
Massage Therapist
Primary
2595
NE
347C00000X
Private Vehicle
G01-370662
NE
Other
Enumeration date
01/07/2019
Last updated
01/07/2019
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