Provider Demographics
NPI:1194739698
Name:TAYLOR, SHAWN K (PT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:K
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SOUTH BROAD ST
Mailing Address - Street 2:STE 2
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115
Mailing Address - Country:US
Mailing Address - Phone:704-660-6551
Mailing Address - Fax:704-660-9894
Practice Address - Street 1:207 SOUTH BROAD ST
Practice Address - Street 2:STE 2
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115
Practice Address - Country:US
Practice Address - Phone:704-660-6551
Practice Address - Fax:704-660-9894
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210646Medicaid
NC2502894Medicare ID - Type Unspecified