Provider Demographics
NPI:1912629643
Name:TAYLOR, ALLYSON BROOK
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:BROOK
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 W GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61607-1746
Mailing Address - Country:US
Mailing Address - Phone:309-839-0470
Mailing Address - Fax:309-839-0664
Practice Address - Street 1:1119 W GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:BARTONVILLE
Practice Address - State:IL
Practice Address - Zip Code:61607-1746
Practice Address - Country:US
Practice Address - Phone:309-839-0470
Practice Address - Fax:309-839-0664
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL356562251X0800X
IL070.0265462251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic