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General NPI Number Information
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NPI Number | 1205185972
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Entity Type | Individual
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Provider Name | AIMEE KIDDY PTA
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Gender | Female
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Dates
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Enumeration Date | 09/10/2012
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 14866 TAMIAMI TRL SUITE A-204
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City | NORTH PORT
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State | FL
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Zip | 34287-2701
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Country | US
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Telephone | 941-423-7705
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Fax |
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Provider Business Mailing Address
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Address Line | 2166 PENFIELD TER
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City | NORTH PORT
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State | FL
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Zip | 34288-6895
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Country | US
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Telephone | 941-423-9760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA4671
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA20722
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License Number State | FL
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