Provider Demographics
NPI:1588088488
Name:TAYLOR, DIANA REBECCA (PTA)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:REBECCA
Last Name:TAYLOR
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 1:3503 PALOMAR VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2869
Mailing Address - Country:US
Mailing Address - Phone:281-851-2749
Mailing Address - Fax:
Practice Address - Street 1:19285 DAVID MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8778
Practice Address - Country:US
Practice Address - Phone:936-321-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2044352225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2044352OtherPTA LICENSE