Provider Demographics
NPI:1811184633
Name:TAYLOR, JODIE SUE (MT)
Entity type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:SUE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 N JOSEY LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2484
Mailing Address - Country:US
Mailing Address - Phone:972-939-6501
Mailing Address - Fax:972-939-6502
Practice Address - Street 1:3730 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2484
Practice Address - Country:US
Practice Address - Phone:972-939-6501
Practice Address - Fax:972-939-6502
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT030146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist