Healthcare Provider Details

I. General information

NPI: 1750576740
Provider Name (Legal Business Name): LATASHA SHONT'A TAYLOR CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7752 BEACON POINT RD
MEMPHIS TN
38125-3462
US

IV. Provider business mailing address

7752 BEACON POINT RD
MEMPHIS TN
38125-3462
US

V. Phone/Fax

Practice location:
  • Phone: 901-756-1942
  • Fax:
Mailing address:
  • Phone: 901-756-1942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number4033
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: