Provider Demographics
NPI:1841506391
Name:TAYLOR, LAURA (DPT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 ARNOLD DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2625
Mailing Address - Country:US
Mailing Address - Phone:218-329-5258
Mailing Address - Fax:
Practice Address - Street 1:1709 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5010
Practice Address - Country:US
Practice Address - Phone:940-696-6200
Practice Address - Fax:940-696-6210
Is Sole Proprietor?:No
Enumeration Date:2010-08-22
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9112225100000X
TX1277147225100000X
MN8543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist