Healthcare Provider Details

I. General information

NPI: 1043042807
Provider Name (Legal Business Name): TAYLOR NICOLE TOLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 MOUNT TABOR RD STE 100
NEW ALBANY IN
47150-6434
US

IV. Provider business mailing address

815 TRIPLETT ST
OWENSBORO KY
42303-3564
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-1007
  • Fax: 502-805-1511
Mailing address:
  • Phone: 270-683-4517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP042233T
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05015828A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: