Provider Demographics
NPI:1053967703
Name:SIAGHA, TAYLOR (PTA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:SIAGHA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 ALTIS WAY # 11201
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-6850
Mailing Address - Country:US
Mailing Address - Phone:973-903-8860
Mailing Address - Fax:
Practice Address - Street 1:7101 ALTIS WAY # 11201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-6850
Practice Address - Country:US
Practice Address - Phone:973-903-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29679225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty