Provider Demographics
NPI:1215215157
Name:PATRICIA A TARUSKI PT PA
Entity Type:Organization
Organization Name:PATRICIA A TARUSKI PT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALGIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:TARUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-471-2406
Mailing Address - Street 1:244 BARRATARIA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-8511
Mailing Address - Country:US
Mailing Address - Phone:904-471-2406
Mailing Address - Fax:904-471-2406
Practice Address - Street 1:855 S HOLMES BLVD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-8347
Practice Address - Country:US
Practice Address - Phone:904-819-1541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 2129261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880034100Medicaid