Healthcare Provider Details

I. General information

NPI: 1376200899
Provider Name (Legal Business Name): TARYN M O'CONNELL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5735 47TH AVE
SACRAMENTO CA
95824-4528
US

IV. Provider business mailing address

5735 47TH AVE
SACRAMENTO CA
95824-4528
US

V. Phone/Fax

Practice location:
  • Phone: 916-643-7400
  • Fax:
Mailing address:
  • Phone: 916-643-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: