Provider Demographics
NPI:1902151087
Name:KIDWELL, RICHARD CHARLES (DPT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHARLES
Last Name:KIDWELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 GLENWOOD ST
Mailing Address - Street 2:111
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4028
Mailing Address - Country:US
Mailing Address - Phone:913-831-2721
Mailing Address - Fax:913-384-0127
Practice Address - Street 1:6400 GLENWOOD ST
Practice Address - Street 2:111
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-4028
Practice Address - Country:US
Practice Address - Phone:913-831-2721
Practice Address - Fax:913-384-0127
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist