Provider Demographics
NPI:1326328246
Name:HEBELER, TARA LYN (DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYN
Last Name:HEBELER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LYN
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4225 ASHER ST
Mailing Address - Street 2:#9
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3654
Mailing Address - Country:US
Mailing Address - Phone:314-283-1613
Mailing Address - Fax:
Practice Address - Street 1:4225 ASHER ST
Practice Address - Street 2:#9
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3654
Practice Address - Country:US
Practice Address - Phone:314-283-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist