Provider Demographics
NPI:1588743835
Name:MCNAMARA, TARA MICHELE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:MICHELE
Last Name:MCNAMARA
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 1:435 W 57TH ST APT 18C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1750
Mailing Address - Country:US
Mailing Address - Phone:212-397-8028
Mailing Address - Fax:212-332-9676
Practice Address - Street 1:435 W 57TH ST APT 18C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1750
Practice Address - Country:US
Practice Address - Phone:212-397-8028
Practice Address - Fax:212-332-9676
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015561-1225100000X
FLPT 15298225100000X
PAPT0009423L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ47291Medicare UPIN