MEDICARE: MICHAEL 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	05014336A	IN

General Provider Information

NPI Number	:	1659047736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TAYLOR PT, DPT

Provider Business Mailing Address
First Line	:	12844 COLDWATER RD STE B
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-8833
Country	:	US
Telephone Number	:	260-497-7191
Fax Number	:

Provider Business Practice Location Address
First Line	:	4303 LAHMEYER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5677
Country	:	US
Telephone Number	:	260-497-7191
Fax Number	:

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

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	08/19/2021

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