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NPI Code Detail

MEDICARE: KRISTIN BROOKE MICAELA TAYLOR PTA

MEDICARE:   KRISTIN BROOKE MICAELA TAYLOR  PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12081S0010XSports Medicine (Physical Medicine & Rehabilitation) Physician2171389TX

General Provider Information

NPI Number : 1659066553
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN BROOKE MICAELA TAYLOR PTA
Provider Business Mailing Address
First Line : 1431 STUDEMONT ST
Second Line :
City : HOUSTON
State : TX
Zip : 77007-3803
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1431 STUDEMONT ST
Second Line :
City : HOUSTON
State : TX
Zip : 77007-3803
Country : US
Telephone Number : 346-701-3820
Fax Number : 346-701-3825
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2023
Last Update Date : 04/06/2023

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Directions to “ KRISTIN BROOKE MICAELA TAYLOR PTA” Practice Location

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