Provider Demographics
NPI:1104869932
Name:CEPAITIS, TARA LYNN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:CEPAITIS
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Gender:F
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:17904 GEORGIA AVENUE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832
Mailing Address - Country:US
Mailing Address - Phone:301-232-1050
Mailing Address - Fax:310-232-1044
Practice Address - Street 1:17904 GEORGIA AVENUE
Practice Address - Street 2:SUITE 215
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832
Practice Address - Country:US
Practice Address - Phone:301-232-1050
Practice Address - Fax:301-232-1044
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-10-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD19507225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD016028D87Medicare ID - Type Unspecified