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General NPI Number Information
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NPI Number | 1477843811
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Entity Type | Individual
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Provider Name | MRS. TARA OSBORNE
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Gender | Female
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 300 STIBNITE AVE UNIT 1
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City | MCCALL
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State | ID
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Zip | 83638-4407
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Country | US
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Telephone | 800-588-2539
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Fax | 208-329-5807
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Provider Business Mailing Address
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Address Line | 13762 NISULA RD
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City | MCCALL
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State | ID
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Zip | 83638-5072
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Country | US
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Telephone | 208-794-6869
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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 | 2551
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License Number State | ID
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