MEDICARE: TARA POOL DPT

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	225100000X	Physical Therapist	PT30852	FL

General Provider Information

NPI Number	:	1164892030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA POOL DPT

Provider Business Mailing Address
First Line	:	100210 OVERSEAS HWY
Second Line	:	SUITE 2
City	:	KEY LARGO
State	:	FL
Zip	:	33037-2526
Country	:	US
Telephone Number	:	618-838-0903
Fax Number	:

Provider Business Practice Location Address
First Line	:	100210 OVERSEAS HWY
Second Line	:	SUITE 2
City	:	KEY LARGO
State	:	FL
Zip	:	33037-2526
Country	:	US
Telephone Number	:	305-453-1088
Fax Number	:

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

Provider Enumeration Date	:	10/04/2015
Last Update Date	:	10/04/2015

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Directions to “ TARA POOL DPT” Practice Location

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