Provider Demographics
NPI:1477232627
Name:FAIR, TAYLOR SUZANNE (PTA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:SUZANNE
Last Name:FAIR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7474 BURTON DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-8998
Mailing Address - Country:US
Mailing Address - Phone:513-498-2635
Mailing Address - Fax:
Practice Address - Street 1:9075 CENTRE POINTE DR STE 200
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4886
Practice Address - Country:US
Practice Address - Phone:513-221-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant