Provider Demographics
NPI:1659872265
Name:POE, TARA ANN (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ANN
Last Name:POE
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 S LOUISE AVE STE 2100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6029
Mailing Address - Country:US
Mailing Address - Phone:605-504-1100
Mailing Address - Fax:
Practice Address - Street 1:911 E 20TH ST STE 300
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1045
Practice Address - Country:US
Practice Address - Phone:605-322-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD03962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer