Provider Demographics
NPI:1639068927
Name:CALDWELL, TARA JORDAN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:JORDAN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 HICKS PIKE
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-5891
Mailing Address - Country:US
Mailing Address - Phone:606-356-4559
Mailing Address - Fax:
Practice Address - Street 1:101 SEXTON WAY
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:KY
Practice Address - Zip Code:40347-7800
Practice Address - Country:US
Practice Address - Phone:859-846-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist