Provider Demographics
NPI:1942835962
Name:TAYLOR, KATHRYN (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
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 1:3884 MEADOW RIDGE DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8330
Mailing Address - Country:US
Mailing Address - Phone:910-975-0595
Mailing Address - Fax:
Practice Address - Street 1:750 WILLIAMSBURG CT NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2539
Practice Address - Country:US
Practice Address - Phone:704-239-6321
Practice Address - Fax:844-708-0619
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist