Provider Demographics
NPI:1841436839
Name:TAYLOR, CHARLOTTE ANN (PT)
Entity type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5307
Mailing Address - Country:US
Mailing Address - Phone:702-951-2243
Mailing Address - Fax:702-951-2262
Practice Address - Street 1:2835 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5307
Practice Address - Country:US
Practice Address - Phone:702-951-2243
Practice Address - Fax:702-951-2262
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBI869YMedicare PIN