Provider Demographics
NPI:1528786480
Name:EBERSOLE, TARA (PT, DPT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:EBERSOLE
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 1:187 THOMAS JOHNSON DR STE 6
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4382
Mailing Address - Country:US
Mailing Address - Phone:301-473-5945
Mailing Address - Fax:301-473-5901
Practice Address - Street 1:11670 OLD NATIONAL PIKE STE 101
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6123
Practice Address - Country:US
Practice Address - Phone:301-473-5945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist