Individual
TARA MARIE JAEGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT, ATC
Contact information
Practice address
3491 UNIVERSITY DR S, FARGO, ND 58104-6225
(701) 412-1873
Mailing address
3426 23RD ST S, MOORHEAD, MN 56560-5314
(701) 412-1873
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
471-12
ND
225100000X
Physical Therapist
Primary
1993
ND
2251P0200X
Pediatric Physical Therapist
1993
ND
Other
Enumeration date
07/30/2014
Last updated
11/17/2022
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