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NPI Code Detail

MEDICARE: TARA WOODWARD PTA

MEDICARE: TARA WOODWARD PTA
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
1225200000XPhysical Therapy AssistantPTA 21784FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PTA 21784OTHERFLPTA LICENSE

General Provider Information

NPI Number : 1760857759
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA WOODWARD PTA
Provider Business Mailing Address
First Line : 255 E MAIN ST
Second Line :
City : LAKE ALFRED
State : FL
Zip : 33850-2133
Country : US
Telephone Number : 863-956-0411
Fax Number :
Provider Business Practice Location Address
First Line : 255 E MAIN ST
Second Line :
City : LAKE ALFRED
State : FL
Zip : 33850-2133
Country : US
Telephone Number : 863-956-0411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2015
Last Update Date : 10/13/2016

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