Individual
THERESA WIEDERODER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1178 PUA MELIA ST, KALAHEO, HI 96741
(989) 859-2222
Mailing address
PO BOX 1268, KALAHEO, HI 96741-1268
(989) 859-2222
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501003076
MI
225100000X
Physical Therapist
PT3563
HI
Other
Enumeration date
10/23/2012
Last updated
10/23/2012
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