Provider Demographics
NPI:1861273336
Name:PARK, TARYN NICHOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:NICHOLE
Last Name:PARK
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 1:500 BRICKELL AVE APT 3803
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2589
Mailing Address - Country:US
Mailing Address - Phone:480-278-5311
Mailing Address - Fax:
Practice Address - Street 1:162 NE 25TH ST STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4852
Practice Address - Country:US
Practice Address - Phone:305-735-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist