Provider Demographics
NPI:1427407816
Name:GUARDALABENE, TAYLOR RAE (PT, DPT, ATC)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:RAE
Last Name:GUARDALABENE
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 PARK CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5082
Mailing Address - Country:US
Mailing Address - Phone:704-323-3208
Mailing Address - Fax:704-323-3240
Practice Address - Street 1:710 PARK CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5082
Practice Address - Country:US
Practice Address - Phone:704-323-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19217225100000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0397730030OtherNSC #