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NPI Code Detail

MEDICARE: TARA ZRALLACK SLP

MEDICARE: TARA ZRALLACK SLP
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
1235Z00000XSpeech-Language PathologistSA7080FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1SA7080OTHERFLSPEECH LANGUAGE PATHOLOGY LICENSE

General Provider Information

NPI Number : 1508001256
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA ZRALLACK SLP
Provider Business Mailing Address
First Line : 4150 INDIAN RIVER BLVD
Second Line :
City : VERO BEACH
State : FL
Zip : 32967-7224
Country : US
Telephone Number : 772-299-6914
Fax Number : 772-299-6915
Provider Business Practice Location Address
First Line : 4150 INDIAN RIVER BLVD
Second Line :
City : VERO BEACH
State : FL
Zip : 32967-7224
Country : US
Telephone Number : 772-299-6914
Fax Number : 772-299-6915
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2008
Last Update Date : 12/10/2008

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Directions to “ TARA ZRALLACK SLP” Practice Location

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