Healthcare Provider Details

I. General information

NPI: 1215977160
Provider Name (Legal Business Name): TAYLOR REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WELTON WAY SUITE B
MOORESVILLE NC
28117-9163
US

IV. Provider business mailing address

114 WELTON WAY SUITE B
MOORESVILLE NC
28117-9163
US

V. Phone/Fax

Practice location:
  • Phone: 704-660-6551
  • Fax: 704-660-9894
Mailing address:
  • Phone: 704-660-6551
  • Fax: 704-660-9894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5450
License Number StateNC

VIII. Authorized Official

Name: MR. SHAWN K TAYLOR
Title or Position: PRESIDENT OWNER
Credential: PT
Phone: 704-660-6551