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General NPI Number Information
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NPI Number | 1306015185
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Entity Type | Individual
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Provider Name | MARCIA W KIDDER P.T.
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Gender | Female
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 02/02/2010
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Provider Practice Location Address
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Address Line | 391 SOUTHCREST CIR SUITE 205
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6730
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Country | US
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Telephone | 662-536-0900
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Fax | 662-536-0914
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Provider Business Mailing Address
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Address Line | 391 SOUTHCREST CIR SUITE 205
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6730
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Country | US
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Telephone | 662-536-0900
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Fax | 662-536-0914
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT0274
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License Number State | MS
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