Provider Demographics
NPI:1134329444
Name:ALBRIGHT, TARA L (DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:ALBRIGHT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10700
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-5517
Mailing Address - Country:US
Mailing Address - Phone:970-241-5856
Mailing Address - Fax:970-241-8599
Practice Address - Street 1:3150 N 12TH ST
Practice Address - Street 2:GARDEN LEVEL
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-2863
Practice Address - Country:US
Practice Address - Phone:970-241-5856
Practice Address - Fax:970-241-8599
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO840999425013OtherHMO
COP00425149OtherMEDICARE RAILROAD
CO840999425013OtherHMO
COC810010Medicare PIN