Provider Demographics
NPI:1639166630
Name:WIDING, DREW ERIC (PT)
Entity Type:Individual
Prefix:MR
First Name:DREW
Middle Name:ERIC
Last Name:WIDING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 BURGUNDY LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3401
Mailing Address - Country:US
Mailing Address - Phone:937-291-1931
Mailing Address - Fax:
Practice Address - Street 1:2800 Q ST
Practice Address - Street 2:BLDG 824
Practice Address - City:WPAFB
Practice Address - State:OH
Practice Address - Zip Code:45433-7947
Practice Address - Country:US
Practice Address - Phone:937-255-1236
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-0053702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic