Provider Demographics
NPI:1679023030
Name:TAYLOR, KAITLYN (PT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:SLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:8936 SOUTH SHELBY
Practice Address - Street 2:STE A-1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6264
Practice Address - Country:US
Practice Address - Phone:317-888-3838
Practice Address - Fax:317-865-7262
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012254A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist