Active NPI
Briana Nicole Kidd I, DPT
- Physical Therapist
- Lake Mary, FL
National Provider Identifier
1629540059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT28478
- Practice address
- 100 Waymont CT
Lake Mary, FL 32746-3412 - Phone
- (407) 323-0399
- NPI assigned
- Dec 25, 2018
- Sex
- Female
- 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 | PT28478 | FL | Primary |
Addresses
Primary practice location
100 Waymont CT
Lake Mary, FL 32746-3412
Mailing address
605 Banderas Ave
Ocoee, FL 34761-2908
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT28478 | Other | FL | FLORIDA DEPARTMENT OF HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba EdemaCare
- Rehabilitation Clinic/Center
- Altamonte Springs, FL
- NPI 1912456799
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545696000000",
"number": "1629540059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "605 BANDERAS AVE",
"city": "OCOEE",
"state": "FL",
"postal_code": "347612908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 WAYMONT CT",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327463412",
"telephone_number": "407-323-0399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDD",
"first_name": "BRIANA",
"middle_name": "NICOLE",
"name_suffix": "I",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-12-25",
"last_updated": "2018-12-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT28478",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA DEPARTMENT OF HEALTH",
"identifier": "PT28478",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Mary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.