Provider Demographics
NPI:1134329931
Name:CANTORE, TARAH FRIEND (PT, CWS)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:FRIEND
Last Name:CANTORE
Suffix:
Gender:F
Credentials:PT, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-2146
Mailing Address - Country:US
Mailing Address - Phone:802-748-3473
Mailing Address - Fax:
Practice Address - Street 1:570 SUMMER ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2146
Practice Address - Country:US
Practice Address - Phone:802-748-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist