Provider Demographics
NPI:1295473759
Name:GILLIAM, TAYLOR LAYNE (DPT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LAYNE
Last Name:GILLIAM
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 1:5102 EXCHANGE CT
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-6514
Mailing Address - Country:US
Mailing Address - Phone:865-803-3206
Mailing Address - Fax:
Practice Address - Street 1:420 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2504
Practice Address - Country:US
Practice Address - Phone:423-297-1813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic