Provider Demographics
NPI:1376200899
Name:O'CONNELL, TARYN M (DPT)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:M
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 E BIDWELL ST STE 130
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3897
Mailing Address - Country:US
Mailing Address - Phone:916-853-0255
Mailing Address - Fax:916-853-0259
Practice Address - Street 1:115 NATOMA ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2615
Practice Address - Country:US
Practice Address - Phone:916-355-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist