Provider Demographics
NPI:1306966221
Name:BIDWELL, RALPH (PT)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:BIDWELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 WHIRLWIND DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7542
Mailing Address - Country:US
Mailing Address - Phone:719-266-1101
Mailing Address - Fax:719-266-1101
Practice Address - Street 1:4386 TRAIL BOSS DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7512
Practice Address - Country:US
Practice Address - Phone:303-688-8666
Practice Address - Fax:303-688-8260
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COB085701OtherIHP PROVIDER ID#
COB085701OtherIHP PROVIDER ID#