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General NPI Number Information
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NPI Number | 1689233785
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Entity Type | Individual
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Provider Name | TARA ANNE CONDON MA, AT, ATC
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Gender | Female
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 801 EDITH RD
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City | LOUISVILLE
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State | KY
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Zip | 40206-2280
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Country | US
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Telephone | 845-521-4398
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Fax |
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Provider Business Mailing Address
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Address Line | 9522 W HIGHLAND AVE
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City | PHOENIX
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State | AZ
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Zip | 85037-1075
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Country | US
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Telephone |
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | AT-008909
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License Number State | AZ
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