Provider Demographics
NPI:1770159048
Name:TAYLOR, CIARA JO (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CIARA
Middle Name:JO
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21009 76TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7105
Mailing Address - Country:US
Mailing Address - Phone:425-672-2910
Mailing Address - Fax:425-778-1872
Practice Address - Street 1:21009 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7105
Practice Address - Country:US
Practice Address - Phone:425-672-2910
Practice Address - Fax:425-778-1872
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61133009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0439056OtherLABOR & INDUSTRY
WAPT61133009OtherDEPARTMENT OF HEALTH
WAG9029194OtherMEDICARE