Provider Demographics
NPI:1033969803
Name:LAMADE, TAYLOR MIDGETTE (DPT, PT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MIDGETTE
Last Name:LAMADE
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 N MERIDIAN PL
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7215
Mailing Address - Country:US
Mailing Address - Phone:907-631-4029
Mailing Address - Fax:907-631-4128
Practice Address - Street 1:984 N MERIDIAN PL
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7215
Practice Address - Country:US
Practice Address - Phone:907-631-4029
Practice Address - Fax:907-631-4128
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK219881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist