| Doctor Name: | MR. RANDY C SIDWELL |
| NPI Number: | 1962547257 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, MS, ATC |
| License Number: | PT-1535 |
| Business Practice Address: | 333 N 18th Ave Ste D2 Pocatello, ID - 832013358 |
| Business Phone Number: | 2082326490 |
| Business Fax Number: | 2082344805 |
| Mailing Address: | 333 N 18th Ave Ste D2, POCATELLO |
| State: | ID |
| Postal Code: | 832013358 |
| Phone Number: | 2082326490 |
| Fax Number: | 2082344805 |
| NPI Enumeration Date: | 02/21/2007 |
| NPI Last Update Date: | 03/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT-1535 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| 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 |