Provider Demographics
NPI:1992109409
Name:WILMOTH, TAYLOR (DAT, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:WILMOTH
Suffix:
Gender:F
Credentials:DAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9387 W 33RD LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2068
Mailing Address - Country:US
Mailing Address - Phone:405-361-1131
Mailing Address - Fax:
Practice Address - Street 1:1507 LEVANTE AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2416
Practice Address - Country:US
Practice Address - Phone:305-284-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 38992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer