Provider Demographics
NPI:1730371535
Name:EGAN, TARA C (PT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:C
Last Name:EGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 W ARGYLE ST # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1312
Mailing Address - Country:US
Mailing Address - Phone:773-988-6629
Mailing Address - Fax:
Practice Address - Street 1:2009 W ARGYLE ST # 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1312
Practice Address - Country:US
Practice Address - Phone:773-988-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70013383174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist