Healthcare Provider Details

I. General information

NPI: 1104412915
Provider Name (Legal Business Name): TARA LOWY ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA SCHEEL

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26720 N 10TH LN
PHOENIX AZ
85085-6379
US

IV. Provider business mailing address

26720 N 10TH LN
PHOENIX AZ
85085-6379
US

V. Phone/Fax

Practice location:
  • Phone: 602-919-0486
  • Fax:
Mailing address:
  • Phone: 602-919-0486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number2000001843
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: