Provider Demographics
NPI:1801868831
Name:COLORIO, TARA A (PT)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:A
Last Name:COLORIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14 BORDER AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-1534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:319A SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2598
Practice Address - Country:US
Practice Address - Phone:508-832-2628
Practice Address - Fax:508-832-7824
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0398292Medicaid
MA469963OtherTUFTS
MAFALLONOther45509
MAY67719OtherBLUE SHIELD
MAY67719OtherBLUE SHIELD