Individual
KAREN S WIDDOES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, MDT
Contact information
Practice address
4102 OGLETOWN STANTON RD, NEWARK, DE 19713-4169
(302) 894-1800
(302) 894-1811
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
J10000289
DE
225100000X
Physical Therapist
PT008698E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0682261000
AMERIHEALTH/IBC
PA
01
—
0682261000
AMERIHEALTH IBC
—
05
—
1000038044
—
DE
01
—
336345
MAMSI
—
01
—
J10000289
DE LICENSE
DE
01
—
PT008698E
PA LICENSE
PA
Enumeration date
06/11/2006
Last updated
01/20/2012
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