Tara Rene Dull, PT
Individual provider Active NPI Physical Therapist · Waunakee, WI
NPI 1104016385 · NPPES record last updated Jul 25, 2007
Key facts
- NPI
- 1104016385
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 9548024 (WI)
- Practice address
- 626 N Meadowbrook LN
Waunakee, WI 53597-2830 - Phone
- (608) 849-5881
- NPI assigned
- Jul 25, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fox Rehabilitation Services Wi LLC
Practice addresses (Care Compare)
2130 Continental Dr
West Bend, WI 53095-7904
Phone (262) 338-0092
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141031000040 | WI | Practitioner - Physical Therapist in Private Practice | 3870714082 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9548024 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aegis Group Practice LLC | Physical Therapist | Current | Accepting new patients |
| Aegis Group Practice LLC | Physical Therapist | Current |
Accepting new patients |
| Aegis Group Practice LLC | Physical Therapist | Current |
Accepting new patients |
| Fox Rehabilitation Services Wi LLC | Physical Therapist | Current |
Accepting new patients |
Locations
4933 Old Greenwood Rd
Fort Smith, AR 72903
N48W14250 Hampton Rd
Menomonee Falls, WI 53051
Phone (262) 781-6930
111 Owen Rd
Monona, WI 53716
Phone (608) 441-9990
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9548024 | WI | Yes |
Addresses
Primary practice location
626 N Meadowbrook LN
Waunakee, WI 53597-2830
Mailing address
626 N Meadowbrook LN
Waunakee, WI 53597-2830
Phone (608) 849-5881
Other providers in Waunakee, WI
- Dean Retail Services, Inc.
- Twila Ann Dekanich
- Deborah Jane Dennis
- Elizabeth A Dillon
- Noelle K. Dowling
- Nikara Durst
- Suzanne J Dynneson
- Jacinda Eskander Edgar
- Kristin Lynn Eklof
- William Edward Emmons
All providers in Waunakee, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.