| Doctor Name: | MICHAEL ANTHONY KIDWELL |
| NPI Number: | 1144693631 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, DPT |
| License Number: | 006742 |
| Business Practice Address: | 708 Westport Rd 200 Elizabethtown, KY - 427013819 |
| Business Phone Number: | 2707661213 |
| Business Fax Number: | 2707661115 |
| Mailing Address: | 708 Westport Rd, 200 ELIZABETHTOWN |
| State: | KY |
| Postal Code: | 427013819 |
| Phone Number: | 2707661213 |
| Fax Number: | 2707661115 |
| NPI Enumeration Date: | 11/05/2015 |
| NPI Last Update Date: | 11/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 006742 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |