Provider Demographics
NPI:1386372605
Name:EASLEY, TAYLOR JORDAN (DPT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JORDAN
Last Name:EASLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9242 WOODLAWN AVE N APT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3542
Mailing Address - Country:US
Mailing Address - Phone:253-315-1871
Mailing Address - Fax:
Practice Address - Street 1:201 YALE AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5430
Practice Address - Country:US
Practice Address - Phone:206-624-7602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61327591208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation