Provider Demographics
NPI:1750648762
Name:TAYLOR-WALDEN, TAMMY LOUISE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LOUISE
Last Name:TAYLOR-WALDEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10281 S WILDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BROOKSTON
Mailing Address - State:IN
Mailing Address - Zip Code:47923-8357
Mailing Address - Country:US
Mailing Address - Phone:765-563-3001
Mailing Address - Fax:
Practice Address - Street 1:10281 S WILDWOOD CT
Practice Address - Street 2:
Practice Address - City:BROOKSTON
Practice Address - State:IN
Practice Address - Zip Code:47923-8357
Practice Address - Country:US
Practice Address - Phone:765-563-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06000870A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist