Healthcare Provider Details

I. General information

NPI: 1144425158
Provider Name (Legal Business Name): PATRICIA LOUISE TAYLOR P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 MARIN ST
THOUSAND OAKS CA
91360-4261
US

IV. Provider business mailing address

308 BAXTER ST
NEWBURY PARK CA
91320-5065
US

V. Phone/Fax

Practice location:
  • Phone: 805-230-2323
  • Fax:
Mailing address:
  • Phone: 805-499-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: