Provider Demographics
NPI:1851418958
Name:TAYLOR, SUSAN M (PT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 BRAND RD
Mailing Address - Street 2:
Mailing Address - City:CABLE
Mailing Address - State:OH
Mailing Address - Zip Code:43009-9629
Mailing Address - Country:US
Mailing Address - Phone:937-653-0101
Mailing Address - Fax:
Practice Address - Street 1:6048 WOODSVIEW WAY
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-6922
Practice Address - Country:US
Practice Address - Phone:614-293-6384
Practice Address - Fax:614-293-7648
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4996OtherLICENSURE NUMBER