Provider Demographics
NPI:1730202532
Name:CHLEBISCH, TARYN KATHLEEN (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:TARYN
Middle Name:KATHLEEN
Last Name:CHLEBISCH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 FAU BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6437
Mailing Address - Country:US
Mailing Address - Phone:561-395-2920
Mailing Address - Fax:561-395-2960
Practice Address - Street 1:3848 FAU BLVD STE 105
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6437
Practice Address - Country:US
Practice Address - Phone:561-395-2920
Practice Address - Fax:561-395-2960
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000007742225100000X
FLPT22538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446664OtherGROUP MEDICARE PIN
TN3650136Medicare PIN