Provider Demographics
NPI:1417178989
Name:SAVAGE, TARA C (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:C
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:M
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:6900 DELLA DR
Mailing Address - Street 2:UNIT #19
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5404
Mailing Address - Country:US
Mailing Address - Phone:917-693-9319
Mailing Address - Fax:
Practice Address - Street 1:311 W BASS ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5011
Practice Address - Country:US
Practice Address - Phone:407-870-5959
Practice Address - Fax:407-933-6468
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist