Provider Demographics
NPI:1417488552
Name:REINHARDT, TARA KRISTIN (DPT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:KRISTIN
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 OCEAN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6050
Mailing Address - Country:US
Mailing Address - Phone:310-994-1182
Mailing Address - Fax:
Practice Address - Street 1:417 OCEAN AVE APT 2
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6050
Practice Address - Country:US
Practice Address - Phone:310-994-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT42717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist