Active NPI
Jack Kidwell
- Physical Therapist
- Middleburg Heights, OH
National Provider Identifier
1659504868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT9064
- Practice address
- 18697 Bagley Rd
Middleburg Heights, OH 44130-3417 - Phone
- (216) 926-0699
- NPI assigned
- Sep 3, 2009
- Last updated
- Apr 14, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT9064 | OH | Primary |
| Physical Therapy Clinic/Center | 261QP2000X | PT9064 | OH |
Addresses
Primary practice location
18697 Bagley Rd
Middleburg Heights, OH 44130-3417
Mailing address
321 Barrett Rd
Berea, OH 44017-1063
Phone (216) 926-0699
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT9064 | OH | MD | Physical Therapy Clinic/Center |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Just in Time Therapy, Inc | Physical Therapist | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Avon Lake, OH
- NPI 1972732774
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460592000000",
"number": "1659504868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 BARRETT RD",
"city": "BEREA",
"state": "OH",
"postal_code": "440171063",
"telephone_number": "216-926-0699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18697 BAGLEY RD",
"city": "MIDDLEBURG HEIGHTS",
"state": "OH",
"postal_code": "441303417",
"telephone_number": "216-926-0699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDWELL",
"first_name": "JACK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-09-03",
"last_updated": "2016-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "PT9064",
"primary": true
},
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "OH",
"license": "PT9064",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middleburg Heights, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.