Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2159933 | TX |
NPI | 1013593375 |
---|---|
Provider Name | Taylor Carroll |
First Address | Dallas, TX 75251-3221 |
Second Address | Dallas, TX 75251-3221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2021 |
Last Update Date | 18/03/2021 |