Provider Demographics
NPI:1962705947
Name:JOSEPH, TARAH R (DPT)
Entity type:Individual
Prefix:MRS
First Name:TARAH
Middle Name:R
Last Name:JOSEPH
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 1:7 NEPONSET ST
Mailing Address - Street 2:PO BOX 60081
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2794
Mailing Address - Country:US
Mailing Address - Phone:508-459-5000
Mailing Address - Fax:508-459-5900
Practice Address - Street 1:7 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2794
Practice Address - Country:US
Practice Address - Phone:508-459-5000
Practice Address - Fax:508-459-5900
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist