Individual
TARA CANOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
80 SOUTH PRESCOTT STREET, MOMENTUM PHYSICAL REHABILITATION, LLC, MEMPHIS, TN 38111-4635
(901) 257-3422
(901) 257-3423
Mailing address
80 SOUTH PRESCOTT STREET, MOMENTUM PHYSICAL REHABILITATION, LLC, MEMPHIS, TN 38111-4635
(901) 257-3422
(901) 257-3423
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA000005668
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0446657
—
TN
01
—
4004523
BSBST
TN
Enumeration date
06/19/2015
Last updated
06/19/2015
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