Provider Demographics
NPI:1306176904
Name:TAYLOR, PATRICIA GAIL (LMT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:GAIL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:GAIL
Other - Last Name:OTERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1621 SW OPEN SANDS LOOP
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32331-3615
Mailing Address - Country:US
Mailing Address - Phone:850-948-2999
Mailing Address - Fax:
Practice Address - Street 1:348 N FLETCHER AVE
Practice Address - Street 2:HIGHWAY 51 NORTH
Practice Address - City:MAYO
Practice Address - State:FL
Practice Address - Zip Code:32066-4502
Practice Address - Country:US
Practice Address - Phone:386-294-2346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA39314225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist