Individual
MRS. TARA ANN ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1002 FOREST DR, RIVERTON, WY 82501-2918
(307) 856-9471
Mailing address
6856 RIVERVIEW RD, RIVERTON, WY 82501-9322
(307) 857-3138
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-0454
WY
Other
Enumeration date
01/02/2019
Last updated
01/02/2019
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