Provider Demographics
NPI:1407583602
Name:KINNISON, TAYLOR (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:KINNISON
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 1:1821 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4021
Mailing Address - Country:US
Mailing Address - Phone:706-861-7471
Mailing Address - Fax:706-861-7472
Practice Address - Street 1:1821 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4021
Practice Address - Country:US
Practice Address - Phone:706-861-7471
Practice Address - Fax:706-861-7472
Is Sole Proprietor?:No
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist