Lorena Elizabeth Tidwell, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT2882 Issued in TX

Practice address

West End Washinton
Laredo Community College - Athletic Department
Laredo, TX 78040

Phone

(956) 721-5326

Fax

(956) 721-5877

NPI assigned

Mar 14, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346373602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P140 FORT MCINTOSH",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780404344",
            "telephone_number": "956-723-1153",
            "fax_number": "956-721-5877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WEST END WASHINTON",
            "address_2": "LAREDO COMMUNITY COLLEGE - ATHLETIC DEPARTMENT",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "78040",
            "telephone_number": "956-721-5326",
            "fax_number": "956-721-5877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "LORENA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT2882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Therapy Place, LLC
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• Therapy Lane Pediatric Rehabilitation
• Therapy Space PLLC
• Ian Murchie Thompson III, M.D.
• Kathy Ann Tienda, COTA
• Martin Tienda, COTA
• Brianna Nicole Tijerina
• Jamie Tijerina
• Michael Anthony Tijerina, NP-C

• Athletic Trainer in Laredo, TX
• Providers in Laredo, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.