Provider Demographics
NPI:1043565898
Name:TAYLOR, LEAH CAMERON (PT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:CAMERON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT
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 1844
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29633-1844
Mailing Address - Country:US
Mailing Address - Phone:864-482-0064
Mailing Address - Fax:864-482-0081
Practice Address - Street 1:100 HEALTHY WAY
Practice Address - Street 2:SUITE 1110
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7915
Practice Address - Country:US
Practice Address - Phone:864-261-3099
Practice Address - Fax:864-261-6617
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist