Provider Demographics
NPI:1730073875
Name:NIDDS, KYRA (ATC)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:NIDDS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4241 E DESERT FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-4001
Mailing Address - Country:US
Mailing Address - Phone:480-404-1699
Mailing Address - Fax:
Practice Address - Street 1:4241 E DESERT FOREST TRL
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-4001
Practice Address - Country:US
Practice Address - Phone:480-404-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer