Doctor Name: | DR. JESSICA J TIDSWELL |
NPI Number: | 1952593568 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT, DPT, SCS, ATC |
License Number: | 5080663-2401 |
Business Practice Address: | 2760 Rasmussen Rd Suite D2-d3 Park City, UT - 840985684 |
Business Phone Number: | 8017185378 |
Business Fax Number: | 8017185378 |
Mailing Address: | 515 Aspen Dr, PARK CITY |
State: | UT |
Postal Code: | 840985134 |
Phone Number: | 8017185378 |
Fax Number: | |
NPI Enumeration Date: | 08/16/2007 |
NPI Last Update Date: | 05/01/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 5080663-2401 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |