Healthcare Provider Details

I. General information

NPI: 1003679358
Provider Name (Legal Business Name): TAYLOR PURNELL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 MCINGVALE RD STE 108
HERNANDO MS
38632-5936
US

IV. Provider business mailing address

632 W POPLAR AVE
COLLIERVILLE TN
38017-2540
US

V. Phone/Fax

Practice location:
  • Phone: 662-469-9054
  • Fax:
Mailing address:
  • Phone: 901-850-5246
  • Fax: 901-850-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7691
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: