Individual
JOSEPH MICHAEL LIDESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.A.
Contact information
Practice address
9047 W GREENFIELD AVE, MILWAUKEE, WI 53214-2808
(414) 453-9290
Mailing address
3901 HARMONY CT, ZION, IL 60099-9548
(262) 902-9780
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2578-19
WI
Other
Enumeration date
11/01/2016
Last updated
11/01/2016
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