Individual
KAYLA TISDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
30330 QUINN RD, TOMBALL, TX 77375-4300
(281) 357-3220
Mailing address
1928 JOHANNA DR APT 202, HOUSTON, TX 77055-1960
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000051398
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000051398
BOC CERTIFICATION
TX
01
—
AT9121
STATE LICENSE
TX
Enumeration date
01/04/2023
Last updated
01/26/2023
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