Individual
TARA CAUDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, PT
Contact information
Practice address
851 4TH AVE E, DICKINSON, ND 58601-4014
(701) 456-7242
Mailing address
851 4TH AVE E, DICKINSON, ND 58601-4014
(701) 456-7242
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1456
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51698
—
ND
01
—
COP28486
BCBS OF ND
ND
01
—
N713425
MEDICARE PART B
ND
Enumeration date
06/25/2007
Last updated
11/01/2023
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