Provider Demographics
NPI:1891363750
Name:DEWEY, TAYLOR R (DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:R
Last Name:DEWEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:R
Other - Last Name:GOLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1443 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2995
Mailing Address - Country:US
Mailing Address - Phone:316-866-7067
Mailing Address - Fax:844-788-4005
Practice Address - Street 1:1443 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2995
Practice Address - Country:US
Practice Address - Phone:168-667-0673
Practice Address - Fax:844-788-4005
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST05509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11-06866OtherSTATE LICENSE