Healthcare Provider Details

I. General information

NPI: 1407513930
Provider Name (Legal Business Name): TARA D CIOCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 CONCORD PIKE STE 4
WILMINGTON DE
19803-5038
US

IV. Provider business mailing address

3300 CONCORD PIKE STE 4
WILMINGTON DE
19803-5038
US

V. Phone/Fax

Practice location:
  • Phone: 302-753-2700
  • Fax:
Mailing address:
  • Phone: 302-753-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003674
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: