Healthcare Provider Details

I. General information

NPI: 1750550422
Provider Name (Legal Business Name): TARA SEGER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N CUMMINGS LN
WASHINGTON IL
61571-2181
US

IV. Provider business mailing address

209 N CUMMINGS LN
WASHINGTON IL
61571-2181
US

V. Phone/Fax

Practice location:
  • Phone: 309-886-2305
  • Fax: 309-444-3893
Mailing address:
  • Phone: 309-886-2305
  • Fax: 309-444-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number160004949
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160004949
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: