Provider Demographics
NPI:1205185972
Name:KIDDY, AIMEE (PTA)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:KIDDY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 PENFIELD TER
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34288-6895
Mailing Address - Country:US
Mailing Address - Phone:941-423-9760
Mailing Address - Fax:
Practice Address - Street 1:14866 TAMIAMI TRL
Practice Address - Street 2:SUITE A-204
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2701
Practice Address - Country:US
Practice Address - Phone:941-423-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA4671225200000X
FLPTA20722225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant