Healthcare Provider Details

I. General information

NPI: 1063530376
Provider Name (Legal Business Name): ROSEMARIE MONAHAN TARARA ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 MONTLIEU AVE HIGH POINT UNIVERSITY
HIGH POINT NC
27262-4221
US

IV. Provider business mailing address

4138 TARRANT TRACE CIR
HIGH POINT NC
27265-3616
US

V. Phone/Fax

Practice location:
  • Phone: 336-841-4616
  • Fax:
Mailing address:
  • Phone: 336-299-5451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0459
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: