Provider Demographics
NPI:1134713332
Name:DICHIARO, TARA ANGIE (PTA)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:ANGIE
Last Name:DICHIARO
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 1:113 LABBY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GROSVENORDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06255-1247
Mailing Address - Country:US
Mailing Address - Phone:860-497-0239
Mailing Address - Fax:860-497-0047
Practice Address - Street 1:113 LABBY RD
Practice Address - Street 2:
Practice Address - City:NORTH GROSVENORDALE
Practice Address - State:CT
Practice Address - Zip Code:06255-1247
Practice Address - Country:US
Practice Address - Phone:860-497-0239
Practice Address - Fax:860-497-0047
Is Sole Proprietor?:No
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001537225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant