MRS. Tara Jean Petersen, P.T.A.

NPI #1366695843 in Lyons, New York

Provider Information

NPI Number: 1366695843
Entity Type: Individual
Name: MRS. Tara Jean Petersen, P.T.A.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Credential: P.T.A.
Enumeration Date: Oct 29, 2008
Last Updated: Oct 29, 2008

Practice Location

Address: 1529 NYE RD
City: Lyons
State: New York
ZIP Code: 14489-9111
Phone: (315) 946-5673

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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