Provider Demographics
NPI:1396159497
Name:TAYLOR, MARY ANN (LMT)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1301 ALLEGHENY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-2455
Mailing Address - Country:US
Mailing Address - Phone:814-207-5294
Mailing Address - Fax:
Practice Address - Street 1:1301 ALLEGHENY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-2455
Practice Address - Country:US
Practice Address - Phone:814-207-5294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG007577225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist