Provider Demographics
NPI:1043805484
Name:BARTEE, TAYLOR M (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:M
Last Name:BARTEE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:TAYLOR
Other - Middle Name:M
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:307 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60433-3266
Mailing Address - Country:US
Mailing Address - Phone:779-279-9728
Mailing Address - Fax:
Practice Address - Street 1:307 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60433-3266
Practice Address - Country:US
Practice Address - Phone:779-279-9728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160008210225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant