Provider Demographics
NPI:1164099149
Name:CARBONETTI, TAYLOR (PT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:CARBONETTI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:DONELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:2700 KESLINGER RD STE C
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4645
Practice Address - Country:US
Practice Address - Phone:630-262-2633
Practice Address - Fax:630-262-2643
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070026083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist