Individual
SCOTT TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
6560 FANNIN ST, SUITE 450, HOUSTON, TX 77030-2761
(713) 357-7440
(713) 357-7401
Mailing address
PO BOX 566, HARDIN, TX 77561-0566
(936) 298-1973
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT2665
TX
Other
Enumeration date
07/26/2007
Last updated
07/26/2007
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