Individual
SHANE VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11260 WILBUR AVE STE 101, NORTHRIDGE, CA 91326-2450
(818) 832-5656
(818) 838-5245
Mailing address
22003 LIGGETT ST, CHATSWORTH, CA 91311-5721
(818) 534-6199
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
53866
CA
Other
Enumeration date
02/06/2025
Last updated
02/06/2025
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