Healthcare Provider Details

I. General information

NPI: 1316638141
Provider Name (Legal Business Name): TARA JOSEPHINE STAUFFER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E ALTAMONTE DR
ALTAMONTE SPRINGS FL
32701-4806
US

IV. Provider business mailing address

4959 KEENELAND CIR
ORLANDO FL
32819-3142
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA32719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: