MEDICARE: DEVAN TAYLOR HOUSHOUR PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA012384	OH

General Provider Information

NPI Number	:	1043804024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVAN TAYLOR HOUSHOUR PTA

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-541-5492
Fax Number	:

Provider Business Practice Location Address
First Line	:	2955 E STATE ST STE 5
Second Line	:
City	:	SALEM
State	:	OH
Zip	:	44460-9307
Country	:	US
Telephone Number	:	234-575-0174
Fax Number	:	234-575-0177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2021
Last Update Date	:	02/21/2021

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Directions to “ DEVAN TAYLOR HOUSHOUR PTA” Practice Location

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