MEDICARE: MRS. TARA LEIGH WISDOM 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	1156069	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8FAV58	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740259308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA LEIGH WISDOM PT

Provider Business Mailing Address
First Line	:	3800 HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7276
Country	:	US
Telephone Number	:	512-876-8595
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7276
Country	:	US
Telephone Number	:	512-876-8595
Fax Number	:

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	02/02/2016

Similar Medicare Providers

1962989145 — MACKENZI J LINDLEY SLP
Practice Location Address:

3800 HULEN ST
FORT WORTH, TX
76107-7276

Practice Phone: 817-569-4300
Practice Fax:

1578557880 — MARGARET L COHENOUR LISW, LCSW
Practice Location Address:

3800 HULEN ST STE 295
FORT WORTH, TX
76107-7276

Practice Phone: 817-255-2636
Practice Fax: 817-266-2657

1497953988 — DAVID BACK CLINIC OF AMERICA
Practice Location Address:

3800 HULEN ST , #110
FORT WORTH, TX
76107-7276

Practice Phone: 817-921-9983
Practice Fax: 817-763-9985

1720247844 — DAVID BACK CLINIC OF AMERICA INC
Practice Location Address:

3800 HULEN ST , SUITE 110
FORT WORTH, TX
76107-7276

Practice Phone: 817-921-9983
Practice Fax: 817-763-9985

1407003197 — MS. SHANA LEIGH HAZZARD LCSW
Practice Location Address:

3800 HULEN ST
FORT WORTH, TX
76107-7276

Practice Phone: 817-255-2612
Practice Fax: 817-735-4926

1154648236 — STACEY LYNN LEWIS LCSW
Practice Location Address:

3800 HULEN ST STE 295
FORT WORTH, TX
76107-7276

Practice Phone: 817-255-2566
Practice Fax: 817-255-2657

Directions to “ MRS. TARA LEIGH WISDOM PT” 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 © 2007-2026 (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.