Provider Demographics
NPI:1356050215
Name:VANCLEAVE, TARA RAE
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:RAE
Last Name:VANCLEAVE
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 1:5310 S BROADWAY CIR APT 6-306
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-6851
Mailing Address - Country:US
Mailing Address - Phone:303-886-8198
Mailing Address - Fax:
Practice Address - Street 1:5310 SOUTH BROADWAY CIRCLE
Practice Address - Street 2:BUILDING 6 APPT 306
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113
Practice Address - Country:US
Practice Address - Phone:303-886-8198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics