Provider Demographics
NPI:1790957868
Name:TAYLOR, TARRA (PT)
Entity Type:Individual
Prefix:
First Name:TARRA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BRANDYWINE BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1590
Mailing Address - Country:US
Mailing Address - Phone:770-460-6285
Mailing Address - Fax:770-460-6512
Practice Address - Street 1:135 BRANDYWINE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1590
Practice Address - Country:US
Practice Address - Phone:770-460-6285
Practice Address - Fax:770-460-6512
Is Sole Proprietor?:No
Enumeration Date:2008-03-29
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist