Provider Demographics
NPI:1407347388
Name:BLACK, TAYLOR NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:NICOLE
Last Name:BLACK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:NICOLE
Other - Last Name:CAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:563 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3752
Mailing Address - Country:US
Mailing Address - Phone:540-534-1338
Mailing Address - Fax:540-301-2778
Practice Address - Street 1:563 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3752
Practice Address - Country:US
Practice Address - Phone:540-534-1338
Practice Address - Fax:540-301-2778
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist