Provider Demographics
NPI:1811175979
Name:ATCHLEY, TARA NICOLE (PT)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:NICOLE
Last Name:ATCHLEY
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 1:13704 BEE TREE CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-1377
Mailing Address - Country:US
Mailing Address - Phone:813-546-8453
Mailing Address - Fax:
Practice Address - Street 1:236 MARINER BLVD
Practice Address - Street 2:KIDS FIRST THERAPY CENTER
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5691
Practice Address - Country:US
Practice Address - Phone:352-683-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888205300Medicaid