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General NPI Number Information
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NPI Number | 1003279340
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Entity Type | Individual
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Provider Name | JOSEPH TARANTINO ATC
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Gender | Male
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 8131 W PARADISE LN
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City | PEORIA
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State | AZ
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Zip | 85382-3826
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Country | US
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Telephone | 619-997-0955
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Fax |
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Provider Business Mailing Address
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Address Line | 9486 N 82ND GLN
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City | PEORIA
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State | AZ
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Zip | 85345-3128
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Country | US
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Telephone | 623-266-9483
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0488
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License Number State | AZ
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