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General NPI Number Information
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NPI Number | 1013373596
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Entity Type | Individual
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Provider Name | ABIGAIL TIDBALL PT
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Gender | Female
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 814 SHANAHAN RD STE 100
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City | LEWIS CENTER
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State | OH
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Zip | 43035-9192
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Country | US
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Telephone | 937-206-2090
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Fax |
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Provider Business Mailing Address
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Address Line | 1776 FORD RD
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City | DELAWARE
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State | OH
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Zip | 43015-7828
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11357
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License Number State | OH
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