MEDICARE: JAMES TAYLOR

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	225100000X	Physical Therapist	PT 2568	AR

General Provider Information

NPI Number	:	1619384302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES TAYLOR

Provider Business Mailing Address
First Line	:	201 DONAGHEY AVE
Second Line	:	PHYSICAL THERAPY CENTER, ROOM 319
City	:	CONWAY
State	:	AR
Zip	:	72035-5001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 DONAGHEY AVE
Second Line	:	PHYSICAL THERAPY CENTER, ROOM 319
City	:	CONWAY
State	:	AR
Zip	:	72035-5001
Country	:	US
Telephone Number	:	501-450-5545
Fax Number	:

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

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	07/15/2014

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