Provider Demographics
NPI:1710002928
Name:HAKALA, TARA ANN (MPT)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:ANN
Last Name:HAKALA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:ANN
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:6444 E SPRING ST STE 641
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1553
Mailing Address - Country:US
Mailing Address - Phone:562-400-8250
Mailing Address - Fax:562-286-9205
Practice Address - Street 1:11462 KENSINGTON RD
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3804
Practice Address - Country:US
Practice Address - Phone:562-400-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist