Healthcare Provider Details

I. General information

NPI: 1407910722
Provider Name (Legal Business Name): TARA PATRICK GARRISON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA LEIGH PATRICK

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 CHESSIE LN
HARPERS FERRY WV
25425-3086
US

IV. Provider business mailing address

441 CHESSIE LN
HARPERS FERRY WV
25425-3086
US

V. Phone/Fax

Practice location:
  • Phone: 626-540-2323
  • Fax:
Mailing address:
  • Phone: 626-540-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT8064
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT003906
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: