Healthcare Provider Details

I. General information

NPI: 1801060785
Provider Name (Legal Business Name): TARA THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1720
US

IV. Provider business mailing address

PO BOX 428
ORCHARD PARK NY
14127-0428
US

V. Phone/Fax

Practice location:
  • Phone: 716-662-4955
  • Fax: 716-972-0338
Mailing address:
  • Phone: 716-662-4955
  • Fax: 716-972-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY EYE
Title or Position: SR VP OF FINANCE
Credential:
Phone: 716-972-2392