Provider Demographics
NPI:1609572668
Name:RITCHERSON, TAYLOR LEE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LEE
Last Name:RITCHERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11705 BUCKTHORN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-2153
Mailing Address - Country:US
Mailing Address - Phone:806-673-9867
Mailing Address - Fax:
Practice Address - Street 1:232 BENS TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-7000
Practice Address - Country:US
Practice Address - Phone:817-654-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2114492225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2114492OtherTEXAS BOARD OF PHYSICAL THERAPY EXAMINERS