Provider Demographics
NPI:1023701380
Name:TAYLOR, TABITHA LYNN (LMT, RYT 200)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMT, RYT 200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:FL
Mailing Address - Zip Code:32033-2112
Mailing Address - Country:US
Mailing Address - Phone:904-669-0902
Mailing Address - Fax:
Practice Address - Street 1:3332 9TH ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:FL
Practice Address - Zip Code:32033-2112
Practice Address - Country:US
Practice Address - Phone:904-669-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA89691225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist