Healthcare Provider Details

I. General information

NPI: 1437450921
Provider Name (Legal Business Name): ASHLEY K TIDBALL HBKIN, PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 INTERNATIONAL PKWY SUITE 300
LAKE MARY FL
32746-5061
US

IV. Provider business mailing address

2507 HAMILTON RD
BRIGHTS GROVE ONTARIO
N0N 1C0
CA

V. Phone/Fax

Practice location:
  • Phone: 407-732-5828
  • Fax: 866-214-4756
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1201708
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: