Doctor Name: | CHRIS L WIDLUND |
NPI Number: | 1881719201 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | MA00017639 |
Business Practice Address: | 20 W Canal St Suite C2 Winooski, VT - 054042131 |
Business Phone Number: | 8026547600 |
Business Fax Number: | 8026547601 |
Mailing Address: | 20 W Canal St, Suite C2 WINOOSKI |
State: | VT |
Postal Code: | 054042131 |
Phone Number: | 8026547600 |
Fax Number: | 8026547601 |
NPI Enumeration Date: | 03/21/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA00017639 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |