Provider Demographics
NPI:1306947387
Name:TARR, MICHAEL NOLAN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NOLAN
Last Name:TARR
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 TORONJA WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833
Mailing Address - Country:US
Mailing Address - Phone:916-283-6237
Mailing Address - Fax:
Practice Address - Street 1:7805 LAGUNA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-691-5400
Practice Address - Fax:916-691-5427
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 17220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist