Provider Demographics
NPI:1760545446
Name:TARR, ERIC J (DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:TARR
Suffix:
Gender:M
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 730
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-9610
Mailing Address - Country:US
Mailing Address - Phone:304-743-5551
Mailing Address - Fax:
Practice Address - Street 1:3552 ROUTE 60 EAST
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504
Practice Address - Country:US
Practice Address - Phone:304-733-9560
Practice Address - Fax:304-733-1141
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV0015132251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1714903OtherBLUE CROSS BLUE SHIELD
WV31150445302OtherWORKERS COMP
WV5067551OtherAETNA
WV5162974-001OtherCIGNA
WV5162974-001OtherCIGNA
WVTA0834334Medicare ID - Type UnspecifiedBARBOURSVILLE, WV CLINIC
WVTA0834331Medicare ID - Type UnspecifiedHURRICANE, WV CLINIC