Individual
JOHN EDWARD KIDDY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC, LAT, CSCS
Contact information
Practice address
777 GLADES RD, BOCA RATON, FL 33431-6424
(561) 297-2043
(561) 297-0468
Mailing address
3109 SAN CLARA DR APT A, DELRAY BEACH, FL 33445-5430
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
AL2789
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03070219
NATABOC CERTIFIED ATHLETIC TRAINER
—
Enumeration date
07/24/2008
Last updated
04/24/2012
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