Provider Demographics
NPI:1124244124
Name:TAYLOR, PANNETTA D (PT)
Entity type:Individual
Prefix:
First Name:PANNETTA
Middle Name:D
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:PO BOX 796
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346
Mailing Address - Country:US
Mailing Address - Phone:814-677-1390
Mailing Address - Fax:814-677-1393
Practice Address - Street 1:224 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346
Practice Address - Country:US
Practice Address - Phone:814-677-1390
Practice Address - Fax:814-677-1393
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007198L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist