Provider Demographics
NPI:1114441714
Name:CICERO, TAYLOR MCGINLEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MCGINLEY
Last Name:CICERO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:MCGINLEY
Other - Last Name:GERCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:3584 SPRINGHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-4141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3584 SPRINGHURST BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-4141
Practice Address - Country:US
Practice Address - Phone:502-339-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist