Provider Demographics
NPI:1992450746
Name:SZWANDRAK, TARA NANCY (PT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:NANCY
Last Name:SZWANDRAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SHIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1378
Mailing Address - Country:US
Mailing Address - Phone:908-892-8143
Mailing Address - Fax:
Practice Address - Street 1:3 WALTER E FORAN BLVD.
Practice Address - Street 2:SUITE 305
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822
Practice Address - Country:US
Practice Address - Phone:908-892-8895
Practice Address - Fax:908-782-4765
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01023400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist