Provider Demographics
NPI:1104016385
Name:DULL, TARA RENE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:RENE
Last Name:DULL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 N MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2830
Mailing Address - Country:US
Mailing Address - Phone:608-849-5881
Mailing Address - Fax:
Practice Address - Street 1:626 N MEADOWBROOK LN
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2830
Practice Address - Country:US
Practice Address - Phone:608-849-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9548024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist