Healthcare Provider Details

I. General information

NPI: 1811481922
Provider Name (Legal Business Name): GENEVIEVE TATARA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34434 KING STREET ROW UNIT 1
LEWES DE
19958-4787
US

IV. Provider business mailing address

659 S SALISBURY BLVD STE 1B
SALISBURY MD
21801-5458
US

V. Phone/Fax

Practice location:
  • Phone: 302-200-9920
  • Fax: 302-703-6652
Mailing address:
  • Phone: 410-831-3226
  • Fax: 410-677-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJT-0000952
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: