Provider Demographics
NPI:1124585435
Name:WARF, TARA MORGAN (DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MORGAN
Last Name:WARF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:MORGAN
Other - Last Name:ROBERSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 724557
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31139-1557
Mailing Address - Country:US
Mailing Address - Phone:757-873-4115
Mailing Address - Fax:757-873-9619
Practice Address - Street 1:3135 PEOPLES ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4130
Practice Address - Country:US
Practice Address - Phone:423-454-1006
Practice Address - Fax:423-328-7825
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12160OtherPT LICENSE