Healthcare Provider Details

I. General information

NPI: 1801099551
Provider Name (Legal Business Name): THOMAS JAMES TAGGART PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W 16TH ST
EUREKA KS
67045-1064
US

IV. Provider business mailing address

129 TIFFANY LN
EUREKA KS
67045-2160
US

V. Phone/Fax

Practice location:
  • Phone: 620-583-7451
  • Fax:
Mailing address:
  • Phone: 620-583-6144
  • Fax: 620-583-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-01585
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: