Provider Demographics
NPI:1104599687
Name:MERIDETH, TAYLOR E (PTA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:E
Last Name:MERIDETH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14811 WEST RD APT 5203
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3180
Mailing Address - Country:US
Mailing Address - Phone:318-332-6034
Mailing Address - Fax:
Practice Address - Street 1:14811 WEST RD APT 5203
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-3180
Practice Address - Country:US
Practice Address - Phone:318-332-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2149933225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant