Provider Demographics
NPI:1356682595
Name:TAYLOR, SONGA (LMT)
Entity Type:Individual
Prefix:
First Name:SONGA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51621
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76206-1621
Mailing Address - Country:US
Mailing Address - Phone:214-223-8237
Mailing Address - Fax:
Practice Address - Street 1:4770 HWY 121
Practice Address - Street 2:STE 180
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-2913
Practice Address - Country:US
Practice Address - Phone:214-223-8237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT111601174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist