Provider Demographics
NPI:1760160626
Name:JEZUIT, TAYLOR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:JEZUIT
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 1:14270 W INDIAN SCHOOL RD STE C4
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9201
Mailing Address - Country:US
Mailing Address - Phone:162-344-0444
Mailing Address - Fax:623-440-4445
Practice Address - Street 1:14270 W INDIAN SCHOOL RD STE C4
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9201
Practice Address - Country:US
Practice Address - Phone:623-440-4445
Practice Address - Fax:623-440-5558
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-33000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist