Provider Demographics
NPI:1124685839
Name:HIATT, EMILY TAYLOR (DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:TAYLOR
Last Name:HIATT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 HICKORY WOODS DR NE APT 139
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-6361
Mailing Address - Country:US
Mailing Address - Phone:276-733-2343
Mailing Address - Fax:
Practice Address - Street 1:1000 LITTON LN
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6399
Practice Address - Country:US
Practice Address - Phone:540-953-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist