Provider Demographics
NPI:1033881354
Name:TAYLOR, WILLIAM ANTHONY (DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANTHONY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1564
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-1564
Mailing Address - Country:US
Mailing Address - Phone:501-352-1874
Mailing Address - Fax:501-457-9090
Practice Address - Street 1:1214 SALEM ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019
Practice Address - Country:US
Practice Address - Phone:501-915-4354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist