Provider Demographics
NPI:1851869499
Name:KIDD, MOLLY (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:KIDD
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 MOSS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2918
Mailing Address - Country:US
Mailing Address - Phone:626-826-5433
Mailing Address - Fax:
Practice Address - Street 1:1320 COLLABORATIVE WAY
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-9081
Practice Address - Country:US
Practice Address - Phone:512-570-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT51482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer