Provider Demographics
NPI:1245870609
Name:TAYLOR, BECKY JEAN (PTA)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:JEAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 PRIVATE ROAD 2008
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-2229
Mailing Address - Country:US
Mailing Address - Phone:254-697-1079
Mailing Address - Fax:
Practice Address - Street 1:378 PRIVATE ROAD 2008
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2229
Practice Address - Country:US
Practice Address - Phone:254-697-1079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2034932208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation