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Individual

MS. TARA A DAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C, ATC

Contact information

Practice address
235 S 33RD ST, PHILADELPHIA, PA 19104-6322
(800) 789-7366
Mailing address
239 GLEN VIEW TER, ABINGDON, MD 21009-3114
(203) 258-7023

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
000133
CT
2255A2300X
Athletic Trainer
A0000485
MD
363AM0700X
Medical Physician Assistant
Primary
MA064151
PA

Other

Enumeration date
01/23/2007
Last updated
11/05/2022
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