Provider Demographics
NPI:1386601698
Name:TAYLOR-GORE, JEANNE (PTA)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:TAYLOR-GORE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 HARTLAND RD
Mailing Address - Street 2:#401
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-3500
Mailing Address - Country:US
Mailing Address - Phone:703-641-5800
Mailing Address - Fax:
Practice Address - Street 1:2841 HARTLAND RD
Practice Address - Street 2:#401
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-3500
Practice Address - Country:US
Practice Address - Phone:703-641-5800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000275225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant