Provider Demographics
NPI:1407327307
Name:HIBBARD, TARA MICHELLE (PTA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MICHELLE
Last Name:HIBBARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8353 HIGHWAY 100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-4190
Mailing Address - Country:US
Mailing Address - Phone:629-888-5800
Mailing Address - Fax:
Practice Address - Street 1:8353 HIGHWAY 100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-4190
Practice Address - Country:US
Practice Address - Phone:629-888-5800
Practice Address - Fax:629-888-5805
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5531225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant