Individual ProviderJohanna L. VidolaOccupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address4647 Medical Dr, San Antonio, TX 78229-4403(210) 358-2710(210) 358-9172PECOS EnrollmentBased on the most recent information from CMS, provider Johanna L. Vidola does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1013250877Provider TypeIndividualFull NameVidola, Johanna L.GenderFemaleSole ProprietorNoEnumeration Date3/30/2013Last Updated5/27/2015Contact InformationPractice LocationPractice Address4647 Medical Dr, San Antonio, TX 78229-4403Phone(210) 358-2710Fax(210) 358-4738Mailing LocationMailing AddressPO Box 87, San Antonio, TX 78291-0087Phone(210) 358-9172Fax(210) 358-9183Provider TaxonomiesCodeDescriptionLicenseCode225X00000XPrimaryDescriptionOccupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense110580Texas