Provider Demographics
NPI:1366683914
Name:RIEHM, TARA L
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:L
Last Name:RIEHM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4653 GREENRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774
Mailing Address - Country:US
Mailing Address - Phone:260-969-1411
Mailing Address - Fax:260-969-1415
Practice Address - Street 1:10313 ABOITE CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5435
Practice Address - Country:US
Practice Address - Phone:260-969-1411
Practice Address - Fax:260-969-1415
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005402A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist