Provider Demographics
NPI:1134658701
Name:TAYLOR, DANIELLE LURAY (PT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LURAY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:LURAY
Other - Last Name:GUY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23415 THREE NOTCH RD STE 2026
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-4021
Mailing Address - Country:US
Mailing Address - Phone:240-530-8188
Mailing Address - Fax:240-237-8572
Practice Address - Street 1:23415 THREE NOTCH RD STE 2026
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-4021
Practice Address - Country:US
Practice Address - Phone:240-530-8188
Practice Address - Fax:240-237-8572
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist