Provider Demographics
NPI:1356183412
Name:TAGARDA, EDA DOROTHY TADEO (RPT)
Entity type:Individual
Prefix:
First Name:EDA DOROTHY
Middle Name:TADEO
Last Name:TAGARDA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2895 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2415
Mailing Address - Country:US
Mailing Address - Phone:718-233-8293
Mailing Address - Fax:718-701-3133
Practice Address - Street 1:2895 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2415
Practice Address - Country:US
Practice Address - Phone:718-233-8293
Practice Address - Fax:718-701-3133
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052356-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist