Provider Demographics
NPI:1235028077
Name:TARASOV, DAN (PTA)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:TARASOV
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 E MISSION AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-5039
Mailing Address - Country:US
Mailing Address - Phone:509-444-5678
Mailing Address - Fax:
Practice Address - Street 1:8815 E MISSION AVE STE A
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-5039
Practice Address - Country:US
Practice Address - Phone:509-217-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61351858225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant