MEDICARE: TARA LYNN GAUSE 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	PT20406	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00398438	OTHER	FL	RAILROAD MEDICARE
2	Y028LZ	OTHER	FL	MEDICARE

General Provider Information

NPI Number	:	1689630980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA LYNN GAUSE PT

Provider Business Mailing Address
First Line	:	5901 E FOWLER AVE STE 100
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-2305
Country	:	US
Telephone Number	:	813-987-9700
Fax Number	:	813-558-6187

Provider Business Practice Location Address
First Line	:	11286 BOYETTE RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-8021
Country	:	US
Telephone Number	:	813-978-9700
Fax Number	:	813-558-6185

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	04/03/2026

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