Basic Information
| Provider Information | |||||||||
| NPI: | 1275943466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIDWELL | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 SW H K DODGEN LOOP STE 201 | ||||||||
| Address2: | |||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765047056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547749991 | ||||||||
| FaxNumber: | 2547749980 | ||||||||
| Practice Location | |||||||||
| Address1: | 2010 SW H K DODGEN LOOP STE 201 | ||||||||
| Address2: | |||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765047056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547749991 | ||||||||
| FaxNumber: | 2547749980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2014 | ||||||||
| LastUpdateDate: | 04/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 205-7860 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.