Provider Demographics
NPI:1134483605
Name:BIDWELL, KATHLEEN (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BIDWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BATES ST
Mailing Address - Street 2:STE/ 201
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7637
Mailing Address - Country:US
Mailing Address - Phone:207-795-2122
Mailing Address - Fax:207-795-2589
Practice Address - Street 1:77 BATES ST
Practice Address - Street 2:STE/ 201
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7637
Practice Address - Country:US
Practice Address - Phone:207-795-2122
Practice Address - Fax:207-795-2589
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist