=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871441527
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BACKROADS THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2026
-----------------------------------------------------
Last Update Date | 03/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 129 HCR 2226 S
-----------------------------------------------------
City | AQUILLA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76622-2467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-733-7414
-----------------------------------------------------
Fax | 254-330-6730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5086
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76708-0086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-733-7414
-----------------------------------------------------
Fax | 254-330-6730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, SOLE MEMBER
-----------------------------------------------------
Name | TAYLA NICHOLAS TAYLA NICHOLAS
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 254-733-7414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------