Healthcare Provider Details

I. General information

NPI: 1023539087
Provider Name (Legal Business Name): TAYLOR MCKENZIE BAXTER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR MCKENZIE GANTT ATC

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7721 AIRPORT BLVD STE E120
MOBILE AL
36608-5052
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 251-631-3680
  • Fax: 251-631-3681
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2211
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000029044
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH10476
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: