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General NPI Number Information
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NPI Number | 1104351774
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Entity Type | Individual
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Provider Name | WANDA TAYLOR RPTA
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Gender | Female
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 3001 SPRING FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27616-2815
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Country | US
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Telephone | 919-861-2441
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Fax | 866-391-9831
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Provider Business Mailing Address
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Address Line | 4365 ROSWELL DR
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City | MARTINEZ
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State | GA
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Zip | 30907-4504
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Country | US
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Telephone | 706-832-2101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PTA000471
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License Number State | GA
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