Provider Demographics
NPI:1073298543
Name:PLYMALE, TAYLOR BRIANNE (DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BRIANNE
Last Name:PLYMALE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 OLEARY ST APT 201
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1592
Mailing Address - Country:US
Mailing Address - Phone:970-275-9813
Mailing Address - Fax:
Practice Address - Street 1:1016 BROOKS AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:MT
Practice Address - Zip Code:59828-9340
Practice Address - Country:US
Practice Address - Phone:406-961-3841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-27065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist