Provider Demographics
NPI:1356583710
Name:PERRETTA, TARA AUSTINE (PT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:AUSTINE
Last Name:PERRETTA
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 1:73 MULFORD RD.
Mailing Address - Street 2:ANDOVER SUBACUTE AND REHAB
Mailing Address - City:LAFAYETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07848-3603
Mailing Address - Country:US
Mailing Address - Phone:973-383-6200
Mailing Address - Fax:
Practice Address - Street 1:73 MULFORD RD.
Practice Address - Street 2:ANDOVER SUBACUTE AND REHAB
Practice Address - City:LAFAYETTE
Practice Address - State:NJ
Practice Address - Zip Code:07848-3603
Practice Address - Country:US
Practice Address - Phone:973-383-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00459900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist