Provider Demographics
NPI:1508299934
Name:ALLEN, TAYLOR (PTA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:ALLEN
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 1:908 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67487-9156
Mailing Address - Country:US
Mailing Address - Phone:785-223-1074
Mailing Address - Fax:
Practice Address - Street 1:5220 SW 17TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2500
Practice Address - Country:US
Practice Address - Phone:785-271-5533
Practice Address - Fax:785-271-8818
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02591225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant