| Doctor Name: | MS. TARA MAHONEY WILSON |
| NPI Number: | 1114001765 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSPT, OCS, CSCS |
| License Number: | 1824PT |
| Business Practice Address: | 1050 Eastside Highway Corvallis, MT - 59828 |
| Business Phone Number: | 4069613914 |
| Business Fax Number: | 4063635271 |
| Mailing Address: | 336 Fairgrounds Rd, HAMILTON |
| State: | MT |
| Postal Code: | 598403126 |
| Phone Number: | 4063750980 |
| Fax Number: | 4063759938 |
| NPI Enumeration Date: | 10/24/2006 |
| NPI Last Update Date: | 01/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1824PT |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |