| Doctor Name: | JOHN EDWARD KIDDY |
| NPI Number: | 1013172543 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS, ATC, LAT, CSCS |
| License Number: | AL2789 |
| Business Practice Address: | 777 Glades Rd Boca Raton, FL - 334316424 |
| Business Phone Number: | 5612972043 |
| Business Fax Number: | 5612970468 |
| Mailing Address: | 3109 San Clara Dr Apt A, DELRAY BEACH |
| State: | FL |
| Postal Code: | 334455430 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/24/2008 |
| NPI Last Update Date: | 04/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246Z00000X |
| License Number: | AL2789 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |