Provider Demographics
NPI:1861448870
Name:TATARYN, DARCY S (MSPT)
Entity Type:Individual
Prefix:MR
First Name:DARCY
Middle Name:S
Last Name:TATARYN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 STATE ST FL 6
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3757
Mailing Address - Country:US
Mailing Address - Phone:503-364-5313
Mailing Address - Fax:503-364-5296
Practice Address - Street 1:300 GLEN CREEK RD NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3058
Practice Address - Country:US
Practice Address - Phone:503-990-8627
Practice Address - Fax:503-991-8630
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR134720Medicare PIN