Provider Demographics
NPI:1619495280
Name:SALAY, TARA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SALAY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FLORAL LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7459 HIGH MARKET ST
Practice Address - Street 2:STE 6
Practice Address - City:SUNSET BEACH
Practice Address - State:NC
Practice Address - Zip Code:28468
Practice Address - Country:US
Practice Address - Phone:910-579-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist