Provider Demographics
NPI:1316199060
Name:VIDT, ASHLEY LYN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LYN
Last Name:VIDT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:LYN
Other - Last Name:FARABAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:127 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-1141
Mailing Address - Country:US
Mailing Address - Phone:412-608-4586
Mailing Address - Fax:
Practice Address - Street 1:90 HUMBERT LN
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-6549
Practice Address - Country:US
Practice Address - Phone:724-228-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008087225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant