Provider Demographics
NPI:1598473357
Name:JONES, TAYLOR MACKENZIE (DPT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MACKENZIE
Last Name:JONES
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 1:3084 WALDORF MARKET PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4872
Mailing Address - Country:US
Mailing Address - Phone:240-530-8188
Mailing Address - Fax:301-638-0470
Practice Address - Street 1:3084 WALDORF MARKET PL
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4872
Practice Address - Country:US
Practice Address - Phone:240-530-8188
Practice Address - Fax:301-638-0470
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215464225100000X
MD30176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305215464OtherDEPARTMENT OF HEALTH PROFESSIONS