Provider Demographics
NPI:1285181941
Name:MAST, TARA LYNN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNN
Last Name:MAST
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CALIPER OAK CIR
Mailing Address - Street 2:APT 316
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3957
Mailing Address - Country:US
Mailing Address - Phone:330-473-0353
Mailing Address - Fax:
Practice Address - Street 1:1400 CALIPER OAK CIRCLE
Practice Address - Street 2:APT 316
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:330-473-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0165082251G0304X
SC8327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics