Provider Demographics
NPI:1982084588
Name:EDWARDS, TARA (ATC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2168 E SERGEANT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-2238
Mailing Address - Country:US
Mailing Address - Phone:215-840-6794
Mailing Address - Fax:
Practice Address - Street 1:2168 E SERGEANT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-2238
Practice Address - Country:US
Practice Address - Phone:215-840-6794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer