Basic Information
| Provider Information | |||||||||
| NPI: | 1659872265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POE | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6100 S LOUISE AVE STE 2100 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571086029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055041100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 911 E 20TH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053221300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2018 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 0396 | SD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.