Provider Demographics
NPI:1407158520
Name:MARONEY, TARA ANN (PT, DPT, GCS, CEEAA)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:ANN
Last Name:MARONEY
Suffix:
Gender:F
Credentials:PT, DPT, GCS, CEEAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 DIXIE TER
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-2918
Mailing Address - Country:US
Mailing Address - Phone:413-887-9268
Mailing Address - Fax:
Practice Address - Street 1:51 DIXIE TER
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-2918
Practice Address - Country:US
Practice Address - Phone:413-887-9268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT88582251G0304X
MA209202251G0304X
NC13300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist