Provider Demographics
NPI:1013593375
Name:CARROLL, TAYLOR (PTA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:LEVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12222 MERIT DR STE 320
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3221
Mailing Address - Country:US
Mailing Address - Phone:972-546-0411
Mailing Address - Fax:972-559-1867
Practice Address - Street 1:12222 MERIT DR STE 320
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3221
Practice Address - Country:US
Practice Address - Phone:972-546-0411
Practice Address - Fax:972-559-1867
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2159933225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant