Provider Demographics
NPI:1407910722
Name:GARRISON, TARA PATRICK (PT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:PATRICK
Last Name:GARRISON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LEIGH
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:441 CHESSIE LN
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-3086
Mailing Address - Country:US
Mailing Address - Phone:626-540-2323
Mailing Address - Fax:
Practice Address - Street 1:441 CHESSIE LN
Practice Address - Street 2:
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425-3086
Practice Address - Country:US
Practice Address - Phone:626-540-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT8064225100000X
WVPT003906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116807Medicare ID - Type Unspecified