Provider Demographics
NPI:1619493475
Name:QUAGLIA, TAYLOR MAIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MAIN
Last Name:QUAGLIA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 US 70 HWY W STE 120
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2664
Mailing Address - Country:US
Mailing Address - Phone:910-294-8612
Mailing Address - Fax:866-422-6178
Practice Address - Street 1:901 US 70 HWY W STE 120
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-2664
Practice Address - Country:US
Practice Address - Phone:919-294-8612
Practice Address - Fax:866-422-6178
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
NCP18670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC720776Medicaid