Individual
TARA HERIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
425 SUMMIT ST, WILD ROSE, WI 54984-6804
(920) 622-4342
(920) 622-3655
Mailing address
N5436 NUTTER ST, WILD ROSE, WI 54984-6752
(920) 642-0147
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2902
WI
Other
Enumeration date
02/20/2019
Last updated
02/20/2019
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