Provider Demographics
NPI:1891205175
Name:WIDELO KIDS THERAPY LLC
Entity Type:Organization
Organization Name:WIDELO KIDS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WIDELO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:859-749-9305
Mailing Address - Street 1:PO BOX 4561
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40392-4561
Mailing Address - Country:US
Mailing Address - Phone:859-749-9305
Mailing Address - Fax:
Practice Address - Street 1:340 GREENING LN
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-8644
Practice Address - Country:US
Practice Address - Phone:859-749-9305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency