Individual
COLE A TIDEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
5333 N PORT WASHINGTON RD STE B, GLENDALE, WI 53217-4914
(414) 716-1770
(414) 716-1772
Mailing address
33900 HARPER AVE STE 104, CLINTON TWP, MI 48035-4258
(586) 350-2644
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
16080-24
WI
225100000X
Physical Therapist
PT028865
PA
Other
Enumeration date
02/10/2021
Last updated
02/17/2025
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