Provider Demographics
NPI:1538379169
Name:KIDDER, MELISSA SHEARER (DPT)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SHEARER
Last Name:KIDDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 MEADOWAY PARK
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3735
Mailing Address - Country:US
Mailing Address - Phone:614-378-6887
Mailing Address - Fax:
Practice Address - Street 1:OSU SPORTS MEDICINE CENTER
Practice Address - Street 2:2050 KENNY ROAD
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221
Practice Address - Country:US
Practice Address - Phone:614-293-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist