Provider Demographics
NPI:1689282725
Name:TAYLOR, HEATHER (PT, DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
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 1:8708 MEDICAL CITY WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-2414
Mailing Address - Country:US
Mailing Address - Phone:817-514-0519
Mailing Address - Fax:817-840-7226
Practice Address - Street 1:8708 MEDICAL CITY WAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-2414
Practice Address - Country:US
Practice Address - Phone:817-514-0519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1334138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist