Provider Demographics
NPI:1053644708
Name:TAYLOR, KRISTIN (PT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 GROVESNER ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-5620
Mailing Address - Country:US
Mailing Address - Phone:704-649-3105
Mailing Address - Fax:877-260-9741
Practice Address - Street 1:3835 GROVESNER ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-5620
Practice Address - Country:US
Practice Address - Phone:704-649-3105
Practice Address - Fax:877-260-9741
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist