Provider Demographics
NPI:1841302023
Name:KIDD, DENISE L (PT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:KIDD
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 1:31 ENSIGN DR # A
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3773
Mailing Address - Country:US
Mailing Address - Phone:860-409-9125
Mailing Address - Fax:860-674-8031
Practice Address - Street 1:31 ENSIGN DR # A
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3773
Practice Address - Country:US
Practice Address - Phone:860-409-9125
Practice Address - Fax:860-674-8031
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650001157Medicare ID - Type Unspecified