Provider Demographics
NPI:1205230539
Name:TAYLOR, DEVAN (PTA)
Entity Type:Individual
Prefix:
First Name:DEVAN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 OLD SMITHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-6805
Mailing Address - Country:US
Mailing Address - Phone:931-473-8431
Mailing Address - Fax:931-473-3941
Practice Address - Street 1:928 OLD SMITHVILLE RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-6805
Practice Address - Country:US
Practice Address - Phone:931-473-8431
Practice Address - Fax:931-473-3941
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5870225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant