MEDICARE: TAYLOR ALLISON RISSER DPT

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
1	2251X0800X	Orthopedic Physical Therapist		IN

General Provider Information

NPI Number	:	1811632821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR ALLISON RISSER DPT

Provider Business Mailing Address
First Line	:	3245 HEALTH DR STE 100
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-1380
Country	:	US
Telephone Number	:	574-647-2129
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 RIETH BLVD STE 103
Second Line	:
City	:	GOSHEN
State	:	IN
Zip	:	46526-5869
Country	:	US
Telephone Number	:	574-875-9616
Fax Number	:	574-875-9817

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2022
Last Update Date	:	08/31/2022

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