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NPI Code Detail

MEDICARE: TAYLOR SORRELLS

MEDICARE:   TAYLOR  SORRELLS
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 Therapist2019030169MO
2225100000XPhysical Therapist070.025737IL

General Provider Information

NPI Number : 1720633076
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR SORRELLS
Provider Business Mailing Address
First Line : 1214 W LOYOLA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60626-5102
Country : US
Telephone Number : 773-274-1769
Fax Number :
Provider Business Practice Location Address
First Line : 1214 W LOYOLA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60626-5102
Country : US
Telephone Number : 773-274-1769
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2019
Last Update Date : 06/29/2021

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Directions to “ TAYLOR SORRELLS ” Practice Location

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