Provider Demographics
NPI:1417179672
Name:CHEDESTER, TARA SUZANNE (DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:SUZANNE
Last Name:CHEDESTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 COUNTRY CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370
Mailing Address - Country:US
Mailing Address - Phone:412-848-7815
Mailing Address - Fax:
Practice Address - Street 1:3865 TAMPA ROAD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677
Practice Address - Country:US
Practice Address - Phone:813-569-7840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist