National Provider Identifier
Tara Jean Petersen, P.T.A.
Tara Jean Petersen, P.T.A. is listed in the NPPES registry with a primary specialty of Physical Therapy Assistant in Lyons, NY and a listed phone number of (315) 946-5673.
Profile Overview
- NPI
- 1366695843
- Provider Type
- Individual
- Primary Specialty
- Physical Therapy Assistant
- Enumeration Date
- October 29, 2008
- Last Updated
- October 29, 2008
Practice Location
- 1529 Nye RD
- Lyons, NY 14489-9111
Phone: (315) 946-5673
Specialties
- Physical Therapy Assistant (225200000X)
Full Record
- NPI
- 1366695843
- Entity Type
- Individual
- Last Name
- Petersen
- First Name
- Tara
- Middle Name
- Jean
- Name Prefix
- Mrs.
- Credential
- P.T.A.
- Mailing Street Address
- 1529 Nye RD
- Mailing City
- Lyons
- Mailing State
- NY
- Mailing ZIP Code
- 14489-9111
- Mailing Country
- US
- Mailing Phone
- (315) 946-5673
- Mailing Fax
- (315) 946-5880
- Practice Street Address
- 1529 Nye RD
- Practice City
- Lyons
- Practice State
- NY
- Practice ZIP Code
- 14489-9111
- Practice Country
- US
- Practice Phone
- (315) 946-5673
- Practice Fax
- (315) 946-5880
- Enumeration Date
- October 29, 2008
- Last Updated
- October 29, 2008
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physical Therapy Assistant (225200000X)