MEDICARE: TARA MAHONEY WILSON MSPT, OCS, CSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist
2	225100000X	Physical Therapist	PTP-PT-LIC-1824	MT

General Provider Information

NPI Number	:	1114001765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA MAHONEY WILSON MSPT, OCS, CSCS

Provider Business Mailing Address
First Line	:	2740 SOUTH AVE W STE 101
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-5137
Country	:	US
Telephone Number	:	406-543-0617
Fax Number	:	406-728-1085

Provider Business Practice Location Address
First Line	:	2740 SOUTH AVE W STE 101
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-5137
Country	:	US
Telephone Number	:	406-543-0617
Fax Number	:	406-728-1085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	05/15/2019

Similar Medicare Providers

1174523336 — DR. LARRY R. STAYNER M.D.
Practice Location Address:

2740 SOUTH AVE W STE 101
MISSOULA, MT
59804-5137

Practice Phone: 406-728-6101
Practice Fax: 406-721-3278

1013937002 — JENNIFER K HELMER MSPT, CHT
Practice Location Address:

2740 SOUTH AVE W STE 101
MISSOULA, MT
59804-5137

Practice Phone: 406-543-0617
Practice Fax: 406-728-1085

1669676912 — KRISTIN KATHLEEN GREEN DPT, OCS
Practice Location Address:

2740 SOUTH AVE W STE 101
MISSOULA, MT
59804-5137

Practice Phone: 406-543-0617
Practice Fax: 406-728-1085

1487834305 — MRS. AMIE MICHELLE SCHILLINGER PA-C
Practice Location Address:

2740 SOUTH AVENUE WEST , SUITE 101
MISSOULA, MT
59804-5137

Practice Phone: 406-728-6101
Practice Fax: 406-721-3278

1063654283 — TAYLOR BUCKLEY M.D.
Practice Location Address:

2740 SOUTH AVE W STE 101
MISSOULA, MT
59804-5137

Practice Phone: 406-728-6101
Practice Fax: 406-721-3278

1154655777 — KATHLEEN MARKLE RACICOT PA-C
Practice Location Address:

2740 SOUTH AVENUE WEST , SUITE 101
MISSOULA, MT
59804-5137

Practice Phone: 406-728-6101
Practice Fax: 406-721-3278

Directions to “ TARA MAHONEY WILSON MSPT, OCS, CSCS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.