Provider Demographics
NPI:1831658467
Name:SCHIESSLE, TARA RENE (PTA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:RENE
Last Name:SCHIESSLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W NORTH BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5000
Mailing Address - Country:US
Mailing Address - Phone:352-728-6636
Mailing Address - Fax:
Practice Address - Street 1:600 W NORTH BLVD STE D
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5000
Practice Address - Country:US
Practice Address - Phone:352-728-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA29231225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant