Healthcare Provider Details

I. General information

NPI: 1215276548
Provider Name (Legal Business Name): TARA M FERGUSON DOCTORATE OF PHYSICA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA MINKUS DOCTORATE OF PHYSICA

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 SCENERY DRIVE
ELIZABETH PA
15037-2000
US

IV. Provider business mailing address

625 LINCOLN AVE SUITE 209
NORTH CHARLEROI PA
15022-2451
US

V. Phone/Fax

Practice location:
  • Phone: 412-751-0040
  • Fax: 412-751-0041
Mailing address:
  • Phone: 724-483-3610
  • Fax: 724-489-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT022583
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: