Provider Demographics
NPI:1457175457
Name:TAYLOR, AMY M (PTA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MICHELE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1540 MULBERRY HIGHWAY 64 W
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:AR
Mailing Address - Zip Code:72947-8936
Mailing Address - Country:US
Mailing Address - Phone:479-806-3309
Mailing Address - Fax:
Practice Address - Street 1:2120 S WALDRON RD # C
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3689
Practice Address - Country:US
Practice Address - Phone:479-452-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2407225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant