Individual
JACK KIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18697 BAGLEY RD, MIDDLEBURG HEIGHTS, OH 44130-3417
(216) 926-0699
Mailing address
321 BARRETT RD, BEREA, OH 44017-1063
(216) 926-0699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT9064
OH
261QP2000X
Physical Therapy Clinic/Center
PT9064
OH
Other
Enumeration date
09/03/2009
Last updated
04/14/2016
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