Individual
MRS. TARA D HUMPHREYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
275 W BASSETT RD, SHELBYVILLE, IN 46176-8574
(317) 392-2161
(317) 398-1870
Mailing address
12345 E LEGAL TENDER RD, COLUMBUS, IN 47203-9424
(812) 350-7495
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
36001308A
IN
Other
Enumeration date
10/03/2015
Last updated
10/03/2015
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