Healthcare Provider Details

I. General information

NPI: 1891167946
Provider Name (Legal Business Name): TARA MARIE THOMPSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA MARIE FAHRNER DPT

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N MONTANA ST
DILLON MT
59725-3308
US

IV. Provider business mailing address

110 N MONTANA ST
DILLON MT
59725-3308
US

V. Phone/Fax

Practice location:
  • Phone: 406-988-0155
  • Fax:
Mailing address:
  • Phone: 406-988-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9377
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License NumberPTP-PT-LIC-9377
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: