Provider Demographics
NPI:1679867063
Name:TALLARINO, TERI ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:ANN
Last Name:TALLARINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2209
Mailing Address - Country:US
Mailing Address - Phone:315-281-8170
Mailing Address - Fax:
Practice Address - Street 1:407 BEECH ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2209
Practice Address - Country:US
Practice Address - Phone:315-281-8170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012543-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist