Provider Demographics
NPI:1871000729
Name:TOMASSACCI, TARYN BLAKE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TARYN
Middle Name:BLAKE
Last Name:TOMASSACCI
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 1:12 ANDOVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2674
Mailing Address - Country:US
Mailing Address - Phone:908-642-5134
Mailing Address - Fax:
Practice Address - Street 1:10 STERLING DR
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4911
Practice Address - Country:US
Practice Address - Phone:732-917-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-01
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE010104225200000X
NJ40QB00346000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant