Individual
JOSEPH ANDREW TIBBALS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
301 LARGO RD, LARGO, MD 20774-2109
(301) 322-0510
Mailing address
301 LARGO RD, LARGO, MD 20774-2109
(301) 322-0510
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
463
NE
Other
Enumeration date
08/19/2009
Last updated
08/19/2009
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