Provider Demographics
NPI:1386288827
Name:TECH, TARA CHRISTINA (TAIJIFIT INSTRUCTOR)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:CHRISTINA
Last Name:TECH
Suffix:
Gender:F
Credentials:TAIJIFIT INSTRUCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 AUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-4341
Mailing Address - Country:US
Mailing Address - Phone:928-582-1469
Mailing Address - Fax:
Practice Address - Street 1:546 6TH ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2014
Practice Address - Country:US
Practice Address - Phone:928-582-1469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer