MEDICARE: JEANNE TAYLOR-GORE 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	2306000275	VA

General Provider Information

NPI Number	:	1386601698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE TAYLOR-GORE PTA

Provider Business Mailing Address
First Line	:	2841 HARTLAND RD
Second Line	:	#401
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043-3500
Country	:	US
Telephone Number	:	703-641-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2841 HARTLAND RD
Second Line	:	#401
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043-3500
Country	:	US
Telephone Number	:	703-641-5800
Fax Number	:

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	07/08/2007

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