Provider Demographics
NPI:1467146217
Name:WADE, TAYLOR (DPT)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8072 DUNNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-7513
Mailing Address - Country:US
Mailing Address - Phone:918-688-8585
Mailing Address - Fax:
Practice Address - Street 1:707 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-3226
Practice Address - Country:US
Practice Address - Phone:918-371-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6358261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy