Tara Childers Andrews
Individual provider Active NPI Physical Therapist · Mobile, AL
NPI 1124646849 · NPPES record last updated Jul 9, 2020
Key facts
- NPI
- 1124646849
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PTH5833 (AL)
- Practice address
- 5721 USA Drive North, Hahn 2050
Mobile, AL 36608-0002 - Phone
- (251) 445-9378
- Fax
- (251) 445-9377
- NPI assigned
- Jul 9, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200820001885 | AL | Practitioner - Physical Therapist in Private Practice | 1658797683 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTH5833 | AL | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PTH5833 | AL | Yes |
Addresses
Primary practice location
5721 USA Drive North, Hahn 2050
Mobile, AL 36608-0002
Mailing address
PO Box 40480
Mobile, AL 36640-0480
Phone (251) 434-3626
Other providers in Mobile, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2020. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.