Tara E Smith, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070014654 Issued in IL

Practice address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Phone

(630) 296-2223

NPI assigned

Oct 6, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tara E Rousonelos Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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  NPD (past)
• Athletic and Therapeutic Institute of Joliet LLC

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  NPD (past)
• Athletic and Therapeutic Institute of Naperville, LLC

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  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418947200000",
    "number": "1508953878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18W431 ROOSEVELT RD",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601484142",
            "telephone_number": "630-620-1580",
            "fax_number": "630-620-1588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "TARA",
        "middle_name": "E",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-06",
        "last_updated": "2014-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070014654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00931595",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "ROUSONELOS",
            "middle_name": "E",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Karyn Smith
• Lateena Smith, EDS
• Latrina Smith, LCSW
• Sarah Catherine Smith, M.P.T.
• Tara Smith, LCSW
• William Kelvyn Smith, ED.D.
• Gina Marie Smoger, RDH
• Sneha Naik DDS PLLC
• Bao Ling Pauline Soh
• Rajwant Kaur Sohal

• Physical Therapist in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.