Provider Demographics
NPI:1487286035
Name:ROSSIGNOL, TARA ASHLEY
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ASHLEY
Last Name:ROSSIGNOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65080 ANN ST
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-5108
Mailing Address - Country:US
Mailing Address - Phone:985-640-5077
Mailing Address - Fax:
Practice Address - Street 1:65080 ANN ST
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452-5108
Practice Address - Country:US
Practice Address - Phone:985-640-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3312262255A2300X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer