Active NPI
Bryan Keith Kidd, PT
- Physical Therapist
- Manistee, MI
National Provider Identifier
1104328657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501008939
- Practice address
- 1465 Parkdale Avenue
Manistee, MI 49660 - Phone
- (231) 398-1166
- Fax
- (231) 398-1499
- NPI assigned
- Mar 1, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501008939 | MI | Primary |
Addresses
Primary practice location
1465 Parkdale Avenue
Manistee, MI 49660
Mailing address
1465 Parkdale Avenue
Manistee, MI 49660
Phone (231) 398-1166
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501008939 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519862400000",
"number": "1104328657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1465 PARKDALE AVENUE",
"city": "MANISTEE",
"state": "MI",
"postal_code": "49660",
"telephone_number": "231-398-1166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1465 PARKDALE AVENUE",
"city": "MANISTEE",
"state": "MI",
"postal_code": "49660",
"telephone_number": "231-398-1166",
"fax_number": "231-398-1499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDD",
"first_name": "BRYAN",
"middle_name": "KEITH",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-01",
"last_updated": "2018-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501008939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manistee, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.