Provider Demographics
NPI:1174020507
Name:TAYLOR, RUTH N (PT)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:N
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15575 MARINA DR UNIT 236B
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-2865
Mailing Address - Country:US
Mailing Address - Phone:936-520-0364
Mailing Address - Fax:
Practice Address - Street 1:20873 EVA ST STE C
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-1975
Practice Address - Country:US
Practice Address - Phone:936-520-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist