Healthcare Provider Details

I. General information

NPI: 1144106444
Provider Name (Legal Business Name): TAYLOR GEPHART DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 S MAIN ST
DANVILLE VA
24541-2922
US

IV. Provider business mailing address

13903 E 300TH AVE
MASON IL
62443-2841
US

V. Phone/Fax

Practice location:
  • Phone: 434-822-0484
  • Fax:
Mailing address:
  • Phone: 618-267-7598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217335
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: