Provider Demographics
NPI:1619051349
Name:TAYLOR, TARA HAHN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:HAHN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:ELIZABETH
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:710 W ADALEE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-5513
Mailing Address - Country:US
Mailing Address - Phone:813-784-1934
Mailing Address - Fax:
Practice Address - Street 1:134 E BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8101
Practice Address - Country:US
Practice Address - Phone:813-681-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 20490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist