MEDICARE: KRISTIN COURTNEY TASKA PT

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	4889	SC

General Provider Information

NPI Number	:	1669422366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN COURTNEY TASKA PT

Provider Business Mailing Address
First Line	:	PO BOX 749306
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-9306
Country	:	US
Telephone Number	:	843-443-9368
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 CORPORATE CENTRE DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-7428
Country	:	US
Telephone Number	:	843-443-9368
Fax Number	:	843-916-2348

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	11/03/2024

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