Provider Demographics
NPI:1912387481
Name:TARA, CHETNA
Entity Type:Individual
Prefix:
First Name:CHETNA
Middle Name:
Last Name:TARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 RANDOLPH RD
Mailing Address - Street 2:REHAB DEPARTMENT
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4011 RANDOLPH RD
Practice Address - Street 2:REHAB DEPARTMENT
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-1054
Practice Address - Country:US
Practice Address - Phone:301-933-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-31
Last Update Date:2015-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24721225100000X
DC871568225100000X
NY035479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist