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NPI 1194397893

NPI 1194397893 : TAYLOR TUBERTINI MATTINA PT, DPT : GULFPORT, MS

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General NPI Number Information
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    NPI Number           |    1194397893
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    Entity Type          |    Individual 
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    Provider Name        |    TAYLOR TUBERTINI MATTINA PT, DPT
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    07/13/2021
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    Last Update Date     |    10/12/2021
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Provider Practice Location Address
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    Address Line         |    12449 US 49 SUITE C
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    City                 |    GULFPORT
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    State                |    MS
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    Zip                  |    39503-3950
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    Country              |    US
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    Telephone            |    228-872-6836
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    980 COURTHOUSE RD APT 924 
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    City                 |    GULFPORT
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    State                |    MS
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    Zip                  |    39507-4288
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    Country              |    US
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    Telephone            |    228-324-0264
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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        |    208100000X
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    Taxonomy Name        |    Physical Medicine & Rehabilitation Physician
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    License Number       |    PT-7129
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    License Number State |    MS
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