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General NPI Number Information
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NPI Number | 1710180286
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Entity Type | Individual
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Provider Name | MEGAN LYNN THIEDEMAN M.S.S.
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Gender | Female
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9502 HUEBNER ROAD SUITE 301
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City | SAN ANTONIO
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State | TX
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Zip | 78240
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Country | US
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Telephone | 210-478-5332
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Fax | 210-478-5384
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Provider Business Mailing Address
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Address Line | 2533 GRAYSON WAY
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1836
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Country | US
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Telephone | 210-478-5332
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Fax | 210-478-5384
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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