Basic Information
| Provider Information | |||||||||
| NPI: | 1811481922 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TATARA | ||||||||
| FirstName: | GENEVIEVE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 659 S SALISBURY BLVD STE 1B | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218015458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108313226 | ||||||||
| FaxNumber: | 4106770883 | ||||||||
| Practice Location | |||||||||
| Address1: | 34434 KING STREET ROW UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | LEWES | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199584787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022009920 | ||||||||
| FaxNumber: | 3027036652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2018 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | JT-0000952 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.