Provider Demographics
NPI:1699450049
Name:STUBBS, TASRAH TURNER (PTA)
Entity type:Individual
Prefix:
First Name:TASRAH
Middle Name:TURNER
Last Name:STUBBS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TASRAH
Other - Middle Name:
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1350 CONCOURSE AVE STE 363
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2023
Mailing Address - Country:US
Mailing Address - Phone:901-260-6155
Mailing Address - Fax:901-260-6156
Practice Address - Street 1:1350 CONCOURSE AVE STE 363
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2023
Practice Address - Country:US
Practice Address - Phone:901-260-6155
Practice Address - Fax:901-260-6156
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN927225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant