Provider Demographics
NPI:1740467885
Name:PHAFF, TARA ANN (DPT)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:ANN
Last Name:PHAFF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ANN
Other - Last Name:GALGANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:ST JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780
Mailing Address - Country:US
Mailing Address - Phone:631-432-6729
Mailing Address - Fax:
Practice Address - Street 1:260 SMITHTOWN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767
Practice Address - Country:US
Practice Address - Phone:631-432-6729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030013225100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist