Individual ProviderTara Nelson SmithPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address905 Annadale Rd, Staten Island, NY 10312-4010(718) 984-5826(718) 702-4232PECOS EnrollmentBased on the most recent information from CMS, provider Tara Nelson Smith does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1811391055Provider TypeIndividualFull NameSmith, Tara NelsonCredentialMS, PTGenderFemaleSole ProprietorYesEnumeration Date10/17/2014Last Updated10/17/2014Contact InformationPractice LocationPractice Address905 Annadale Rd, Staten Island, NY 10312-4010Phone(718) 984-5826FaxUnlisted FaxMailing LocationMailing Address70 Downes Ave, Staten Island, NY 10312-4065Phone(718) 702-4232FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense024108New York