Provider Demographics
NPI:1942289350
Name:GARNER, TARA RIMRODT (PT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:RIMRODT
Last Name:GARNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LYNN
Other - Last Name:RIMRODT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3333 W. HEFNER ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120
Mailing Address - Country:US
Mailing Address - Phone:405-751-9955
Mailing Address - Fax:405-751-9988
Practice Address - Street 1:3333 WEST HEFNER ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-751-9955
Practice Address - Fax:405-751-9988
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT3799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK248829503Medicare PIN
OK1244990001Medicare NSC