Provider Demographics
NPI:1780400796
Name:ASSAD, TAYLOR (PT, DPT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:ASSAD
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 1:740 BULL RUN RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15417-9545
Mailing Address - Country:US
Mailing Address - Phone:724-812-2686
Mailing Address - Fax:
Practice Address - Street 1:74 ERIN DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1371
Practice Address - Country:US
Practice Address - Phone:304-594-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist