Basic Information
| Provider Information | |||||||||
| NPI: | 1437328424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIDD | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | BRYAN | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1910 N CHURCH ST | ||||||||
| Address2: | SUITE D | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274055666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362747480 | ||||||||
| FaxNumber: | 3362748903 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 N CHURCH ST | ||||||||
| Address2: | SUITE D | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274055666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362747480 | ||||||||
| FaxNumber: | 3362748903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2008 | ||||||||
| LastUpdateDate: | 05/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | P11526 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7212391 | 05 | NC | MEDICAID | P00678453 | 01 | NC | RAILROAD MEDICARE | OTHER |