Provider Demographics
NPI:1962168518
Name:KILDOW, MISTY N (DPT)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:N
Last Name:KILDOW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:N
Other - Last Name:TWEEDLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1 MEDICAL PARK
Mailing Address - Street 2:PATIENT ACCOUNTING - CREDENTIALING
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6379
Mailing Address - Country:US
Mailing Address - Phone:304-243-8310
Mailing Address - Fax:304-243-8430
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:PEDIATRIC REHABILITATION
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6379
Practice Address - Country:US
Practice Address - Phone:304-243-8310
Practice Address - Fax:304-243-8430
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT003399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist