Provider Demographics
NPI:1316197155
Name:THRASHER, TARA R (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:R
Last Name:THRASHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4717
Mailing Address - Country:US
Mailing Address - Phone:850-291-3743
Mailing Address - Fax:850-432-6870
Practice Address - Street 1:2100 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4717
Practice Address - Country:US
Practice Address - Phone:850-291-3743
Practice Address - Fax:850-432-6870
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA#0030014225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist