Individual
KATIE TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
110 W NORTH ST, GEORGETOWN, DE 19947-2144
(302) 856-4574
Mailing address
28563 COLLINS FARM RD, MILLSBORO, DE 19966-1534
(302) 236-6913
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
J2-0000457
DE
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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