Provider Demographics
NPI:1053923946
Name:VARISCO, TAYLOR (PT, DPT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:VARISCO
Suffix:
Gender:M
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 1:242 HESPER AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3761
Mailing Address - Country:US
Mailing Address - Phone:504-606-6436
Mailing Address - Fax:
Practice Address - Street 1:10001 LAKE FOREST BLVD STE 102
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-6204
Practice Address - Country:US
Practice Address - Phone:504-281-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist