Provider Demographics
NPI:1114176690
Name:FRIEDMAN, TARA MCGANN (DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MCGANN
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:KATHLEEN
Other - Last Name:MCGANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2945 JUNIPERO SERRA BLVD
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2549
Mailing Address - Country:US
Mailing Address - Phone:650-755-8830
Mailing Address - Fax:650-755-8147
Practice Address - Street 1:2945 JUNIPERO SERRA BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2549
Practice Address - Country:US
Practice Address - Phone:650-755-8830
Practice Address - Fax:650-755-8147
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA348922251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic