Individual
MICHELLE VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2265 GLOVER PL, LOS ANGELES, CA 90031-1128
(323) 679-3505
Mailing address
2265 GLOVER PL, LOS ANGELES, CA 90031-1128
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
10945
CA
Other
Enumeration date
09/15/2015
Last updated
09/15/2015
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