Provider Demographics
NPI:1427532662
Name:QUAST, TARA LYNN (PTA)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:LYNN
Last Name:QUAST
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23217 471ST AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MN
Mailing Address - Zip Code:55334-2068
Mailing Address - Country:US
Mailing Address - Phone:507-381-3696
Mailing Address - Fax:
Practice Address - Street 1:1575 HOOVER DR
Practice Address - Street 2:
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003-2667
Practice Address - Country:US
Practice Address - Phone:507-720-6582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2248225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant