Provider Demographics
NPI:1952751372
Name:EDMISTON, TAYLOR (DPT/L)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:EDMISTON
Suffix:
Gender:F
Credentials:DPT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SHERATON DR
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-9316
Mailing Address - Country:US
Mailing Address - Phone:814-949-2050
Mailing Address - Fax:814-949-2051
Practice Address - Street 1:4 SHERATON DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-9316
Practice Address - Country:US
Practice Address - Phone:814-949-2050
Practice Address - Fax:814-949-2051
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist