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General NPI Number Information
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NPI Number | 1306947387
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Entity Type | Individual
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Provider Name | MICHAEL NOLAN TARR PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7805 LAGUNA BLVD SUITE 300
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City | ELK GROVE
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State | CA
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Zip | 95758
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Country | US
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Telephone | 916-691-5400
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Fax | 916-691-5427
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Provider Business Mailing Address
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Address Line | 2812 TORONJA WAY
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City | SACRAMENTO
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State | CA
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Zip | 95833
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Country | US
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Telephone | 916-283-6237
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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 | PT 17220
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License Number State | CA
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