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NPI Code Detail

MEDICARE: TAYLOR LANE WILSON PT, DPT

MEDICARE: TAYLOR LANE WILSON PT, DPT
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
1225100000XPhysical Therapist1247468

General Provider Information

NPI Number : 1538628896
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR LANE WILSON PT, DPT
Provider Business Mailing Address
First Line : 9707 ANDERSON MILL RD STE 340
Second Line :
City : AUSTIN
State : TX
Zip : 78750-0018
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9707 ANDERSON MILL RD STE 340
Second Line :
City : AUSTIN
State : TX
Zip : 78750-0018
Country : US
Telephone Number : 512-258-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2019
Last Update Date : 03/17/2019

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Directions to “ TAYLOR LANE WILSON PT, DPT” Practice Location

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