Provider Demographics
NPI:1700564895
Name:TAYLOR, DEJHIA ALEXANDREA (ATC)
Entity Type:Individual
Prefix:
First Name:DEJHIA
Middle Name:ALEXANDREA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 SNOWDROP DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9777
Mailing Address - Country:US
Mailing Address - Phone:469-789-4748
Mailing Address - Fax:
Practice Address - Street 1:1423 SNOWDROP DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-9777
Practice Address - Country:US
Practice Address - Phone:469-789-4748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20000542112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer