Provider Demographics
NPI:1669480570
Name:SHEEHAN, TARA LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:LYNN
Other - Last Name:JOROKMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9019 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:WEEDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13166-9569
Mailing Address - Country:US
Mailing Address - Phone:315-834-8631
Mailing Address - Fax:
Practice Address - Street 1:2685 ERIE DR
Practice Address - Street 2:RAYMOND PHYSICAL THERAPY PLLC
Practice Address - City:WEEDSPORT
Practice Address - State:NY
Practice Address - Zip Code:13166-3204
Practice Address - Country:US
Practice Address - Phone:315-834-6496
Practice Address - Fax:315-834-6499
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0154741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02140169Medicaid
P32072Medicare UPIN
NY02140169Medicaid