MR. Randy C Sidwell, PT, MS, ATC

NPI #1962547257 in Pocatello, Idaho

Provider Information

NPI Number: 1962547257
Entity Type: Individual
Name: MR. Randy C Sidwell, PT, MS, ATC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: PT, MS, ATC
Enumeration Date: Feb 21, 2007
Last Updated: Mar 15, 2012

Practice Location

Address: 333 N 18TH AVE STE D2
City: Pocatello
State: Idaho
ZIP Code: 83201-3358
Phone: (208) 232-6490

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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