Individual
LISA WIEDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2425 STOCKTON BLVD, SACRAMENTO, CA 95817-2215
(916) 453-2240
(916) 453-2363
Mailing address
2425 STOCKTON BLVD, SACRAMENTO, CA 95817-2215
(916) 453-2240
(916) 453-2363
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
32466
CA
Other
Enumeration date
09/28/2016
Last updated
09/28/2016
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