Provider Demographics
NPI:1093368623
Name:TAYLORED THERAPIES, PLLC
Entity Type:Organization
Organization Name:TAYLORED THERAPIES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:479-903-1018
Mailing Address - Street 1:14 WEBBLY LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-2909
Mailing Address - Country:US
Mailing Address - Phone:479-903-3488
Mailing Address - Fax:855-738-7702
Practice Address - Street 1:1004 BEAU TERRE DR STE 507
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6799
Practice Address - Country:US
Practice Address - Phone:479-903-1018
Practice Address - Fax:855-738-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center