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Search › Illinois › 261QP2000X

Victor Lidaywa, DPT

NPI 1083178198 · on the registry since 2019 · sole proprietor

Practice

Address
1701 W Jackson St
Ste C
Macomb, IL 61455
Phone
(309) 331-3590
Organisation at this address
Graham Hospital Association
Age Rehab & Medical Fitness
Inferred from a shared address, not stated in the registry.

Registry record

Primary taxonomy
261QP2000X
261QP2000X
Also registered as
225100000X
Licence states on file
IL
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2019-02-02

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois