Carl Tidwell
Rehabilitation Practitioner in Las Vegas, NV. Individual provider (NPI-1).
NPI number1982129011
StatusActive
Last updated in NPPESAug 9, 2017
Details
- NPI
- 1982129011
- Entity type
- Individual (NPI-1)
- Name
- Carl Tidwell
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 9, 2017
- Last updated
- Aug 9, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225400000X | Rehabilitation Practitioner | – | – | Yes |
Practice location
3355 Spring Mountain Rd Ste 48Las Vegas, NV 89102-8635
Phone 702-912-5404
Mailing address
3355 Spring Mountain Rd Ste 48Las Vegas, NV 89102-8635
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