Provider Demographics
NPI:1194251090
Name:TAYLOR, WYNDETTA VALENTINE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:WYNDETTA
Middle Name:VALENTINE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13235 OLD FORT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-6449
Mailing Address - Country:US
Mailing Address - Phone:301-257-2111
Mailing Address - Fax:
Practice Address - Street 1:13235 OLD FORT RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-6449
Practice Address - Country:US
Practice Address - Phone:301-257-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist