Provider Demographics
NPI:1417669698
Name:TATARA, JOSEPH ALLEN (DPT, OT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALLEN
Last Name:TATARA
Suffix:
Gender:M
Credentials:DPT, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36879-5408
Mailing Address - Country:US
Mailing Address - Phone:256-656-8053
Mailing Address - Fax:
Practice Address - Street 1:1550 E UNIVERSITY DR APT 224
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6368
Practice Address - Country:US
Practice Address - Phone:601-573-9774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALOT4080225X00000X
ALPTH7916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist