Healthcare Provider Details

I. General information

NPI: 1417669698
Provider Name (Legal Business Name): JOSEPH ALLEN TATARA DPT, OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E UNIVERSITY DR APT 224
AUBURN AL
36830-6368
US

IV. Provider business mailing address

2040 SEQUOIA DR
AUBURN AL
36879-5408
US

V. Phone/Fax

Practice location:
  • Phone: 601-573-9774
  • Fax:
Mailing address:
  • Phone: 256-656-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH7916
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT4080
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: