Basic Information
| Provider Information | |||||||||
| NPI: | 1720336464 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HATFIELD | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | REHAR | ||||||||
| OtherFirstName: | TARA | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | P.O. BOX 4058 | ||||||||
| Address2: | |||||||||
| City: | CROFTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211144058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103157810 | ||||||||
| FaxNumber: | 4103159012 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 WHITEMARSH PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103157810 | ||||||||
| FaxNumber: | 4103159012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2012 | ||||||||
| LastUpdateDate: | 01/22/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 24167 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.