Provider Demographics
NPI:1326457789
Name:PITTS, TARA LYNN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:PITTS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:PA
Mailing Address - Zip Code:19033-1202
Mailing Address - Country:US
Mailing Address - Phone:610-209-6553
Mailing Address - Fax:
Practice Address - Street 1:30 WEST AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3322
Practice Address - Country:US
Practice Address - Phone:610-688-3635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-10
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist