Individual
TARA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2701 CHESTNUT STATION CT, LOUISVILLE, KY 40299-6395
(800) 335-1060
Mailing address
501 N BROADWAY ST, UNION CITY, MI 49094-1146
(517) 652-4882
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502004267
MI
Other
Enumeration date
03/26/2015
Last updated
03/26/2015
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