The Wellness Collaborative

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

THE WELLNESS COLLABORATIVE

Practice address

1343 W 38TH St
Erie, PA 16508-2461

Phone

(814) 315-2548

NPI assigned

Jan 16, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa Marie Vidakovic, PHYSICAL THERAPISTNPI 1073757886

Title

Physical Therapist

Phone

(814) 315-2548

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Marie Vidakovic, P.T.

  • Physical Therapist
  • Erie, PA
  • NPI 1073757886
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547596800000",
    "number": "1154895803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4312 ALISON AVE",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165066164",
            "telephone_number": "814-323-0045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1343 W 38TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165082461",
            "telephone_number": "814-315-2548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WELLNESS COLLABORATIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-16",
        "last_updated": "2019-01-16",
        "status": "A",
        "authorized_official_last_name": "VIDAKOVIC",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "814-315-2548",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Theresa Peterson-Hadden, LLC
• Mark Theuerkauf, MS. NCC.

• Physical Therapist in Erie, PA
• Providers in Erie, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.