Provider Demographics
NPI:1720375280
Name:TAOATAO, GRACE FAITH BAIZA
Entity Type:Individual
Prefix:
First Name:GRACE FAITH
Middle Name:BAIZA
Last Name:TAOATAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACEFAITH
Other - Middle Name:BAIZA
Other - Last Name:TAOATAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1591 DEXTER LAKE DR APT 304
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-1305
Mailing Address - Country:US
Mailing Address - Phone:901-849-0219
Mailing Address - Fax:
Practice Address - Street 1:1591 DEXTER LAKE DR APT 304
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-1305
Practice Address - Country:US
Practice Address - Phone:901-849-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN004427225200000X
TN4427225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant