Individual
ABIGAIL TIDBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
814 SHANAHAN RD STE 100, LEWIS CENTER, OH 43035-9192
(937) 206-2090
Mailing address
1776 FORD RD, DELAWARE, OH 43015-7828
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11357
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0220627
—
OH
Enumeration date
01/13/2016
Last updated
06/12/2019
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