=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578373635
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEXIS S TAYLOR DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2025
-----------------------------------------------------
Last Update Date | 01/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2470 N STOKESBERRY PL
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83646-5035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-884-8323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7201 W CLEARWATER AVE STE B101
-----------------------------------------------------
City | KENNEWICK
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99336-1694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-544-0265
-----------------------------------------------------
Fax | 509-987-1614
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT-8545
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------