Provider Demographics
NPI:1548450521
Name:KIDD, JOSHUA AARON (PT)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:AARON
Last Name:KIDD
Suffix:
Gender:M
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:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-0592
Mailing Address - Country:US
Mailing Address - Phone:503-723-5049
Mailing Address - Fax:503-655-9305
Practice Address - Street 1:25030 SW PARKWAY AVE
Practice Address - Street 2:#101
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9816
Practice Address - Country:US
Practice Address - Phone:503-582-1073
Practice Address - Fax:503-582-1093
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR141601Medicare PIN