Provider Demographics
NPI:1124641345
Name:TAYLOR, AMY ROSE (DPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ROSE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ROSE
Other - Last Name:BAER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:17623 1ST AVE S APT 119
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2712
Mailing Address - Country:US
Mailing Address - Phone:206-508-5750
Mailing Address - Fax:
Practice Address - Street 1:17623 1ST AVE S APT 119
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2712
Practice Address - Country:US
Practice Address - Phone:206-508-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60928600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist