Provider Demographics
NPI:1407488414
Name:MISKECH, TAYLOR A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:A
Last Name:MISKECH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 OLDE REGENT WAY STE 130
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4250
Mailing Address - Country:US
Mailing Address - Phone:910-302-3330
Mailing Address - Fax:
Practice Address - Street 1:2301 S 17TH ST UNIT 2
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7901
Practice Address - Country:US
Practice Address - Phone:910-550-1171
Practice Address - Fax:910-765-0749
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist