Provider Demographics
NPI:1821581984
Name:KANNAS, TARA LEE (DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LEE
Last Name:KANNAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LEE
Other - Last Name:SELVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:509 13TH ST STE B
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:IA
Practice Address - Zip Code:52208-1521
Practice Address - Country:US
Practice Address - Phone:319-434-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist