Individual
MRS. ANGELIA GRACE KIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
168 W COLLEGE AVE, MONTICELLO, AR 71655-4820
(870) 367-4333
Mailing address
207 N FARMVILLE RD, HERMITAGE, AR 71647-9390
(870) 463-8846
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA980
AR
Other
Enumeration date
12/13/2017
Last updated
12/13/2017
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