Provider Demographics
NPI:1457408098
Name:SOCQUET, TARA E (PT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:E
Last Name:SOCQUET
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 1:2515 NW 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-8314
Mailing Address - Country:US
Mailing Address - Phone:650-814-9868
Mailing Address - Fax:
Practice Address - Street 1:8716 E MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2531
Practice Address - Country:US
Practice Address - Phone:360-696-5300
Practice Address - Fax:360-729-3372
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60025787225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT60025787OtherPT LICENSE
WAPT60025787OtherPT LICENSE
WAPT60025787OtherPT LICENSE