Provider Demographics
NPI:1700435286
Name:TAYLOR, IMANI (SPT,ATC)
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:SPT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4785 GUILFORD FOREST DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-7395
Mailing Address - Country:US
Mailing Address - Phone:678-499-6176
Mailing Address - Fax:
Practice Address - Street 1:1601 S MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32307-3105
Practice Address - Country:US
Practice Address - Phone:850-599-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist