Provider Demographics
NPI:1760984751
Name:THOMPSON, TARA GEORGANNE (DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:GEORGANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2593
Mailing Address - Country:US
Mailing Address - Phone:330-498-5222
Mailing Address - Fax:
Practice Address - Street 1:99 SPRING BROOK CT
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:OH
Practice Address - Zip Code:43062-8058
Practice Address - Country:US
Practice Address - Phone:724-554-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.013526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist