Healthcare Provider Details

I. General information

NPI: 1760009799
Provider Name (Legal Business Name): TAYLOR ALEXANDRIA RHODES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 04/13/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 HARRY HINES BLVD
DALLAS TX
75235-1717
US

IV. Provider business mailing address

8915 HARRY HINES BLVD
DALLAS TX
75235-1717
US

V. Phone/Fax

Practice location:
  • Phone: 904-708-1866
  • Fax:
Mailing address:
  • Phone: 904-708-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: