Healthcare Provider Details

I. General information

NPI: 1346557485
Provider Name (Legal Business Name): PATRICIA A TARUSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 BARRATARIA DR
SAINT AUGUSTINE FL
32080-8511
US

IV. Provider business mailing address

244 BARRATARIA DR
SAINT AUGUSTINE FL
32080-8511
US

V. Phone/Fax

Practice location:
  • Phone: 904-471-2406
  • Fax:
Mailing address:
  • Phone: 904-471-2406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT 2129
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: