MEDICARE: MICHAEL TARR PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT025665	PA

General Provider Information

NPI Number	:	1568904514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TARR PT

Provider Business Mailing Address
First Line	:	201 ERIE ST STE B
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1659
Country	:	US
Telephone Number	:	724-458-5850
Fax Number	:	724-458-4402

Provider Business Practice Location Address
First Line	:	201 ERIE ST STE B
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1659
Country	:	US
Telephone Number	:	724-458-5850
Fax Number	:	724-458-4402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	11/08/2016

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