Provider Demographics
NPI:1972195188
Name:ELLIS, TAYLOR PAIGE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:PAIGE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 BRIGHTLING BND
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-1048
Mailing Address - Country:US
Mailing Address - Phone:972-351-2235
Mailing Address - Fax:
Practice Address - Street 1:757 E US HIGHWAY 80 STE 160
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8732
Practice Address - Country:US
Practice Address - Phone:469-663-9596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist