MEDICARE: MR. JAMES KIDD PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305006625	VA
2	225100000X	Physical Therapist	1935	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376674051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES KIDD PT

Provider Business Mailing Address
First Line	:	1903 LOIRE VALLEY RD
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-7631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1903 LOIRE VALLEY RD
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-7631
Country	:	US
Telephone Number	:	423-926-1632
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	06/23/2025

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Directions to “ MR. JAMES KIDD PT” Practice Location

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