Sidwell, Randy C

Sidwell, Randy C is an individual health care provider with primary practice located at 333 N 18Th Ave Ste D2 , Pocatello ID 83201-3358. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Sidwell, Randy C can be contacted via phone (208) 232-6490.

Contact Information

Primary practice address
333 N 18Th Ave Ste D2 Pocatello ID 83201-3358
Phone: (208) 232-6490
Fax: (208) 234-4805
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT-1535 Idaho

Profile Details

NPI number 1962547257
LBN Legal business name Sidwell, Randy C
Credentials PT, MS, ATC
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 21st, 2007
Last updated Mar 15th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962547257 NPPES
Idaho MEDICAID 805846600

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