Healthcare Provider Details

I. General information

NPI: 1982742425
Provider Name (Legal Business Name): TARA MEREDITH FRADELLA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BRIGGS RD
PLAINVIEW NY
11803-6114
US

IV. Provider business mailing address

9 BRIGGS ROAD
PLAINVIEW NY
11803
US

V. Phone/Fax

Practice location:
  • Phone: 516-390-9504
  • Fax:
Mailing address:
  • Phone: 516-390-9504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023493-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: