Provider Demographics
NPI:1215371117
Name:TAYLOR, JACQUELINE KAYE (DPT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:KAYE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:KAYE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RICHARDSON
Mailing Address - Street 1:1309 MYRNA LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-9746
Mailing Address - Country:US
Mailing Address - Phone:501-425-2659
Mailing Address - Fax:
Practice Address - Street 1:3600 RICHARDS RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2921
Practice Address - Country:US
Practice Address - Phone:501-955-2108
Practice Address - Fax:501-955-9517
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist