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General NPI Number Information
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NPI Number | 1619177623
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Entity Type | Individual
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Provider Name | TARA D MARSH DPT
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Gender | Female
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 6305 JEFFERSON SQUARE CT
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City | DECATUR
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State | GA
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Zip | 30030-1787
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Country | US
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Telephone | 817-798-9314
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Fax |
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Provider Business Mailing Address
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Address Line | 6305 JEFFERSON SQUARE CT
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City | DECATUR
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State | GA
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Zip | 30030-1787
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Country | US
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Telephone | 817-798-9314
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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 | 009585
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License Number State | GA
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