Provider Demographics
NPI:1932505518
Name:JANSON, TARA N (PTA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:N
Last Name:JANSON
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 1:6140 SKYLARK ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-3162
Mailing Address - Country:US
Mailing Address - Phone:330-704-2610
Mailing Address - Fax:
Practice Address - Street 1:2910 LERMITAGE PL
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-5219
Practice Address - Country:US
Practice Address - Phone:330-688-1188
Practice Address - Fax:330-688-1278
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09001225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant