Provider Demographics
NPI:1609420082
Name:KIDD, DANIELLE PAIGE (LPTA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:PAIGE
Last Name:KIDD
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 METZE RD APT 13B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-0751
Mailing Address - Country:US
Mailing Address - Phone:304-917-9199
Mailing Address - Fax:
Practice Address - Street 1:801 MUSGROVE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-1752
Practice Address - Country:US
Practice Address - Phone:864-939-8384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4185225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant