Provider Demographics
NPI:1992329254
Name:CARLSON, TAYLOR (DPT)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 S SHASTA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524-8623
Mailing Address - Country:US
Mailing Address - Phone:541-732-5756
Mailing Address - Fax:541-823-3952
Practice Address - Street 1:1332 S SHASTA AVE STE B
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-8623
Practice Address - Country:US
Practice Address - Phone:541-732-5756
Practice Address - Fax:541-826-3952
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist