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General NPI Number Information
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NPI Number | 1891293924
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Entity Type | Individual
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Provider Name | SAMUEL THOMAS TEDTMAN ATC
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Gender | Male
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | GREAT AMERICAN BALL PARK 100 JOE NUXHALL WAY
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City | CINCINNATI
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State | OH
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Zip | 45202
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Country | US
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Telephone | 502-767-3404
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Fax |
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Provider Business Mailing Address
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Address Line | 2009 GRASMERE DR
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City | LOUISVILLE
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State | KY
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Zip | 40205-1507
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Country | US
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Telephone | 502-767-3404
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT7750
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License Number State | TX
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