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General NPI Number Information
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NPI Number | 1164798823
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Entity Type | Individual
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Provider Name | TARA M CRONIN P.T.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 627 MIDDLETON RD
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City | WINONA
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State | MS
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Zip | 38967-2021
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Country | US
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Telephone | 662-283-1260
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Fax |
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Provider Business Mailing Address
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Address Line | 102 COLLEGE ST
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City | LEXINGTON
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State | MS
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Zip | 39095-3110
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Country | US
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Telephone | 601-856-0964
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT2083
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License Number State | MS
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