Basic Information
| Provider Information | |||||||||
| NPI: | 1154889285 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARMON | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 SUSANNAH ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376011748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232829011 | ||||||||
| FaxNumber: | 4232820035 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 MED TECH PKWY STE 115 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376042631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237941300 | ||||||||
| FaxNumber: | 4237941820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2019 | ||||||||
| LastUpdateDate: | 10/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 12156 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 12156 | 01 | TN | PT LICENSE | OTHER |