Provider Demographics
NPI:1679000137
Name:STOVALL, TAYLOR PORTER (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:PORTER
Last Name:STOVALL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JORDAN
Other - Middle Name:TAYLOR
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:605 TREDEGAR RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-8428
Mailing Address - Country:US
Mailing Address - Phone:256-343-3737
Mailing Address - Fax:
Practice Address - Street 1:2300 COLEMAN RD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-6824
Practice Address - Country:US
Practice Address - Phone:256-831-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA7372225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant