Provider Demographics
NPI:1275780074
Name:TAYLOR, KORI DAWN (PTA)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:DAWN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MILLERS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-7408
Mailing Address - Country:US
Mailing Address - Phone:270-804-5780
Mailing Address - Fax:
Practice Address - Street 1:208 MILLERS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-7408
Practice Address - Country:US
Practice Address - Phone:270-804-5780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA10532225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant