Individual
MR. TED R VIDAL II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA, LMT
Contact information
Practice address
2350 IONE RD, LAS VEGAS, NV 89183-7943
(702) 790-3000
Mailing address
6823 PONDEROSA WAY, LAS VEGAS, NV 89118-2100
(702) 665-4054
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
53320
CA
225200000X
Physical Therapy Assistant
Primary
A-1516
NV
225700000X
Massage Therapist
NVMT.5574
NV
Other
Enumeration date
11/10/2022
Last updated
01/09/2025
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