Provider Demographics
NPI:1366494064
Name:BERAN, TARA OKEEFFE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:OKEEFFE
Last Name:BERAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:DAUN
Other - Last Name:OKEEFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:9097 E DESERT COVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-860-4298
Mailing Address - Fax:480-860-0356
Practice Address - Street 1:9097 E DESERT COVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6276
Practice Address - Country:US
Practice Address - Phone:480-860-4298
Practice Address - Fax:480-860-0356
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist