Provider Demographics
NPI:1255445656
Name:TAYLOR, TAMRA KAY (PT)
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:KAY
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:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-0065
Mailing Address - Country:US
Mailing Address - Phone:574-293-9420
Mailing Address - Fax:574-295-8141
Practice Address - Street 1:1628 W BEARDSLEY AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1881
Practice Address - Country:US
Practice Address - Phone:574-293-9420
Practice Address - Fax:574-295-8141
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002601A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1306090EMedicare PIN