Provider Demographics
NPI:1881981546
Name:SWEENEY, TARAH ADRIENNE (DPT)
Entity type:Individual
Prefix:
First Name:TARAH
Middle Name:ADRIENNE
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91292
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99509-1292
Mailing Address - Country:US
Mailing Address - Phone:907-748-0022
Mailing Address - Fax:907-277-0022
Practice Address - Street 1:1343 G ST
Practice Address - Street 2:STE100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4375
Practice Address - Country:US
Practice Address - Phone:907-748-0022
Practice Address - Fax:907-277-0022
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK23352251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1574830Medicaid
AK1574830Medicaid