Individual
TARA SOPRANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, MS
Contact information
Practice address
4050 S 26TH ST, PHILADELPHIA, PA 19112-1613
(484) 383-4495
Mailing address
1910 E PASSYUNK AVE, PHILADELPHIA, PA 19148-2221
(908) 415-5705
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT004675
PA
Other
Enumeration date
01/06/2014
Last updated
01/06/2014
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