Provider Demographics
NPI:1982402194
Name:URIZ, TARA (PT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:URIZ
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:DIDYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5700 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1710
Mailing Address - Country:US
Mailing Address - Phone:510-204-2981
Mailing Address - Fax:
Practice Address - Street 1:3595 MT DIABLO BLVD STE 350
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3849
Practice Address - Country:US
Practice Address - Phone:510-204-2981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist