Provider Demographics
NPI:1518980721
Name:TAYLOR, KRISTIN (MS PT CSCS OCS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS PT CSCS OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5649 SELLS MILL DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2444
Mailing Address - Country:US
Mailing Address - Phone:860-983-5418
Mailing Address - Fax:
Practice Address - Street 1:4821 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9496
Practice Address - Country:US
Practice Address - Phone:614-850-1476
Practice Address - Fax:614-850-1478
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013864225100000X
IN05009305A225100000X
OH012123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK30667Medicare PIN