Provider Demographics
NPI:1851251268
Name:THWAITS, TAYLOR
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:THWAITS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 PINE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT HENRY
Mailing Address - State:OH
Mailing Address - Zip Code:45883-8611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:152 PINE LN
Practice Address - Street 2:
Practice Address - City:SAINT HENRY
Practice Address - State:OH
Practice Address - Zip Code:45883-8611
Practice Address - Country:US
Practice Address - Phone:937-423-9714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA014181225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant