Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 13300 | NC |
Y | 2251G0304X | Physical Therapist - Geriatrics | 20920 | MA |
N | 2251G0304X | Physical Therapist - Geriatrics | 8858 | CT |
NPI | 1407158520 |
---|---|
Provider Name | Dr. Tara Ann Maroney |
First Address | Chicopee, MA 01020-2918 |
Second Address | Chicopee, MA 01020-2918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2010 |
Last Update Date | 05/01/2014 |