Provider Demographics
NPI:1598908535
Name:TAYLOR, JESSICA L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:HOUNTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1961 NC HIGHWAY 172
Mailing Address - Street 2:STE AND106
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-9195
Mailing Address - Country:US
Mailing Address - Phone:636-252-9800
Mailing Address - Fax:
Practice Address - Street 1:10840 LITTLE PATUXENT PKWY STE 403
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3104
Practice Address - Country:US
Practice Address - Phone:410-992-9753
Practice Address - Fax:410-992-0268
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207355225100000X
CA35238225100000X
NC12090225100000X
MD27196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist