Provider Demographics
NPI:1063146660
Name:PERKINS, TARA LEE (DPT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LEE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LEE
Other - Last Name:HEATWOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3234 KENTON CT
Mailing Address - Street 2:
Mailing Address - City:TOANO
Mailing Address - State:VA
Mailing Address - Zip Code:23168-9385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 BULIFANTS BLVD STE A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5711
Practice Address - Country:US
Practice Address - Phone:757-564-7381
Practice Address - Fax:757-564-7391
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist