Provider Demographics
NPI:1407848856
Name:DARGUSCH, TANYA M (ATC/LAT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:M
Last Name:DARGUSCH
Suffix:
Gender:F
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 UPTON WAY
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3619
Mailing Address - Country:US
Mailing Address - Phone:856-227-8812
Mailing Address - Fax:
Practice Address - Street 1:529 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:11-12 WING
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2831
Practice Address - Country:US
Practice Address - Phone:856-589-8500
Practice Address - Fax:856-259-8924
Is Sole Proprietor?:No
Enumeration Date:2005-08-20
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000262002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer