Provider Demographics
NPI:1366641276
Name:TAYLOR, ELISABET MARIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELISABET
Middle Name:MARIA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10066 EDGECOMBE PL NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-4333
Mailing Address - Country:US
Mailing Address - Phone:360-479-4747
Mailing Address - Fax:360-478-6246
Practice Address - Street 1:140 S MARION AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-3639
Practice Address - Country:US
Practice Address - Phone:360-479-4747
Practice Address - Fax:360-478-6246
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000061322251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4111589Medicaid
WA505240Medicare PIN
WA4111589Medicaid