Active NPI
Randall Kidd
- Physical Therapist
- Pembroke Pines, FL
National Provider Identifier
1861826802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT28454
- Practice address
- 9929 Pines Blvd
Pembroke Pines, FL 33024-6175 - Phone
- (954) 437-8099
- NPI assigned
- Aug 27, 2013
- Sex
- Male
- Sole proprietor
- No
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 | PT28454 | FL | Primary |
Addresses
Primary practice location
9929 Pines Blvd
Pembroke Pines, FL 33024-6175
Mailing address
9410 Tangerine PL
406
Davie, FL 33324-4471
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 |
|---|---|---|---|
| PT28454 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cora Health Services, Inc | 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 and National Provider Directory roles.
-
- Rehabilitation Clinic/Center
- Winter Garden, FL
- NPI 1104786805
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377561600000",
"number": "1861826802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9410 TANGERINE PL",
"address_2": "406",
"city": "DAVIE",
"state": "FL",
"postal_code": "333244471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9929 PINES BLVD",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330246175",
"telephone_number": "954-437-8099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDD",
"first_name": "RANDALL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-27",
"last_updated": "2013-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT28454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke Pines, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.