Individual
LISA LYNN WIDDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA, LMT
Contact information
Practice address
5249 E TERRACE DR, MADISON, WI 53718-8339
(608) 222-9777
Mailing address
301 E MAIN ST APT 312, WAUNAKEE, WI 53597-1481
(815) 608-1577
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2260
WI
225700000X
Massage Therapist
15749
WI
Other
Enumeration date
11/02/2022
Last updated
11/02/2022
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