MEDICARE: JAMIE TAYLOR 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
1	225100000X	Physical Therapist	2305216000	VA

General Provider Information

NPI Number	:	1649053380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE TAYLOR PT, DPT

Provider Business Mailing Address
First Line	:	1311 MAMARONECK AVE STE 140
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-5224
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 B ST STE 102
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-2462
Country	:	US
Telephone Number	:	757-548-0014
Fax Number	:

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

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	08/16/2023

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