Provider Demographics
NPI:1003279340
Name:TARANTINO, JOSEPH (ATC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:TARANTINO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9486 N 82ND GLN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-3128
Mailing Address - Country:US
Mailing Address - Phone:623-266-9483
Mailing Address - Fax:
Practice Address - Street 1:8131 W PARADISE LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3826
Practice Address - Country:US
Practice Address - Phone:619-997-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer