Individual
TARA HANNAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
68 ROAD 6118, KIRTLAND, NM 87417-9319
(505) 402-6407
Mailing address
68 ROAD 6118, KIRTLAND, NM 87417-9319
(505) 402-6407
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A-1157
NM
Other
Enumeration date
08/18/2015
Last updated
08/18/2015
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