Provider Demographics
NPI:1750829818
Name:BRACCIANTE, TARA MARIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MARIA
Last Name:BRACCIANTE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:MUNZEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:826 E BALTIMORE PIKE UNIT 9
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1870
Practice Address - Country:US
Practice Address - Phone:610-335-1410
Practice Address - Fax:610-444-3505
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist