Individual
TARA TICOMB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
141 DURHAM RD, STE 14, MADISON, CT 06443-2676
(203) 245-0001
Mailing address
20 OLD HICKORY LN, BRANFORD, CT 06405-2828
(631) 839-1470
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000857
LICENSE #
CT
Enumeration date
08/30/2006
Last updated
07/08/2007
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