Provider Demographics
NPI:1275581746
Name:VIETH, TARA (DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:VIETH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:46161 WESTLAKE DR
Mailing Address - Street 2:STE 330
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5871
Mailing Address - Country:US
Mailing Address - Phone:703-435-6604
Mailing Address - Fax:703-787-6575
Practice Address - Street 1:1860 TOWN CENTER DR
Practice Address - Street 2:SUITE 300
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5896
Practice Address - Country:US
Practice Address - Phone:703-435-6604
Practice Address - Fax:703-787-6575
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2016-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA2305204027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist