Provider Demographics
NPI:1386183903
Name:CHADWICK, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CHADWICK
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 1:3409 W CHESTER PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4290
Mailing Address - Country:US
Mailing Address - Phone:610-557-0220
Mailing Address - Fax:610-557-0221
Practice Address - Street 1:3409 W CHESTER PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4290
Practice Address - Country:US
Practice Address - Phone:610-557-0220
Practice Address - Fax:610-557-0221
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0258572251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic