Healthcare Provider Details

I. General information

NPI: 1134942394
Provider Name (Legal Business Name): TAYLOR LYNNE SOPHIA VANDERS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17507 LEE HWY
ABINGDON VA
24210-7835
US

IV. Provider business mailing address

PO BOX 3562
WISE VA
24293-3562
US

V. Phone/Fax

Practice location:
  • Phone: 276-525-6043
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16142
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP037149T
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: