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General NPI Number Information
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NPI Number | 1356050215
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Entity Type | Individual
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Provider Name | TARA RAE VANCLEAVE
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Gender | Female
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 5310 SOUTH BROADWAY CIRCLE BUILDING 6 APPT 306
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City | ENGLEWOOD
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State | CO
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Zip | 80113
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Country | US
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Telephone | 303-886-8198
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Fax |
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Provider Business Mailing Address
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Address Line | 5310 S BROADWAY CIR APT 6-306
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City | ENGLEWOOD
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State | CO
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Zip | 80113-6851
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Country | US
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Telephone | 303-886-8198
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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