MEDICARE: MRS. SUMMER L TAYLOR 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	PTA19453	FL

General Provider Information

NPI Number	:	1558406454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUMMER L TAYLOR PTA

Provider Business Mailing Address
First Line	:	1004 EMPORIA RD
Second Line	:
City	:	PIERSON
State	:	FL
Zip	:	32180-2714
Country	:	US
Telephone Number	:	386-749-4588
Fax Number	:

Provider Business Practice Location Address
First Line	:	1764 S WOODLAND BLVD
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-7915
Country	:	US
Telephone Number	:	386-734-9400
Fax Number	:	386-734-8866

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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