Provider Demographics
NPI:1942477856
Name:SOUVE, TARA JEAN (PT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:JEAN
Last Name:SOUVE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RHCI FOR CHILDREN 280 D ROUTE 130
Mailing Address - Street 2:SUITE 7
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02644
Mailing Address - Country:US
Mailing Address - Phone:508-833-1060
Mailing Address - Fax:
Practice Address - Street 1:280D ROUTE 130 STE 7
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:MA
Practice Address - Zip Code:02644-1140
Practice Address - Country:US
Practice Address - Phone:508-833-1060
Practice Address - Fax:508-833-2216
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist