Provider Demographics
NPI:1841206265
Name:VIDA, SARA LYNN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:LYNN
Last Name:VIDA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 TURK RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49267-8733
Mailing Address - Country:US
Mailing Address - Phone:734-856-7048
Mailing Address - Fax:
Practice Address - Street 1:9800 TURK RD
Practice Address - Street 2:
Practice Address - City:OTTAWA LAKE
Practice Address - State:MI
Practice Address - Zip Code:49267-8733
Practice Address - Country:US
Practice Address - Phone:734-856-7048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer