Individual
MRS. TRACIE ANNE VIDAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4313 WASHINGTON RD, KENOSHA, WI 53144-1501
(262) 654-2800
(262) 654-2800
Mailing address
4313 WASHINGTON RD, KENOSHA, WI 53144-1501
(262) 654-2800
(262) 654-2800
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1101-19
WI
Other
Enumeration date
05/26/2012
Last updated
05/26/2012
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