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General NPI Number Information
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NPI Number | 1760054258
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Entity Type | Individual
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Provider Name | EMILY KIDD PTA
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Gender | Female
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 43 WILLIAM B GRAHAM CT
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City | KILMARNOCK
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State | VA
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Zip | 22482-3852
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Country | US
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Telephone | 804-435-8501
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Fax |
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Provider Business Mailing Address
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Address Line | 7621 ELKO RD
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City | SANDSTON
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State | VA
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Zip | 23150-5810
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Country | US
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Telephone |
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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 |
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License Number State |
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