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General NPI Number Information
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NPI Number | 1184779787
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Entity Type | Individual
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Provider Name | TARA J DERINGOR P.T.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5425 BAUM BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15232-1201
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Country | US
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Telephone | 412-365-6065
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Fax | 412-365-6060
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Provider Business Mailing Address
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Address Line | 1125 WIGHTMAN ST
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City | PITTSBURGH
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State | PA
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Zip | 15217-1049
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Country | US
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Telephone | 412-521-4576
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Fax | 412-421-0312
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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 | 011637L
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License Number State | PA
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