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Individual
TARA E SMITH
Active
Individual
TARA E SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070014654
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00931595
MEDICARE RAILROAD
IL
Enumeration date
10/06/2006
Last updated
12/19/2014
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