Individual
TARA EILEEN PATRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1252 CONWAY AVE, COSTA MESA, CA 92626-2747
(703) 509-7574
Mailing address
1252 CONWAY AVE, COSTA MESA, CA 92626-2747
(703) 509-7574
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
53281
CA
Other
Enumeration date
09/15/2025
Last updated
10/24/2025
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