Individual
MRS. LORI WIEDOWER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1301 RUSSELL RD, RUSSELLVILLE, AR 72802-4320
(479) 967-2316
(479) 967-3639
Mailing address
P.O. DRAWER 2109, RUSSELLVILLE, AR 72811
(479) 967-2322
(479) 967-2876
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 1017
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127158721
—
AR
Enumeration date
10/03/2006
Last updated
01/31/2023
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