| Doctor Name: | MRS. LISA MARIE VIDAKOVIC |
| NPI Number: | 1073757886 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.T. |
| License Number: | PTO17348 |
| Business Practice Address: | 8155 Oliver Rd Erie, PA - 165094683 |
| Business Phone Number: | 8148665930 |
| Business Fax Number: | 8148681767 |
| Mailing Address: | 1337 W 6th St, ERIE |
| State: | PA |
| Postal Code: | 165052503 |
| Phone Number: | 8144566000 |
| Fax Number: | 8144566060 |
| NPI Enumeration Date: | 04/23/2009 |
| NPI Last Update Date: | 04/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PTO17348 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |