Individual
DEBORAH LOUISE WIDELO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, MS, PCS
Contact information
Practice address
340 GREENING LN, WINCHESTER, KY 40391
(859) 749-9305
(859) 737-3513
Mailing address
PO BOX 4561, 340 GREENING LANE, WINCHESTER, KY 40392-4561
(859) 749-9305
(859) 737-3513
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
003026
KY
2251P0200X
Pediatric Physical Therapist
003026
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP-206
—
KY
Enumeration date
10/31/2006
Last updated
10/12/2015
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